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The 
NORTH CAROLINA 

REGISTER 



IN THIS ISSUE 




EXECUTIVE ORDERS 



FINAL DECISION LETTER 



PROPOSED RULES 




Environment, Health, and Natural Resources 


Human Resources 




Insurance 




Secretary of State 




FINAL RULES 


** C *'VtO 


Correction 

List of Rules Codified 

ARRC OBJECTIONS 


APR 1* 799/ 



RULES INVALIDATED BY JUDICIAL DECISION 



ISSUE DATE: APRIL 15, 1991 
Volume 6 • Issue 2 • Pages 45-99 



INFORMATION ABOUT THE NORTH CAROLINA REGISTER AND ADMINISTRATIVE CODE 



NORTH CAROLINA REGISTER 

The North Carolina Register is published bi-monthly 
and contains information relating to agency, executive, 
legislative and judicial actions required by or affecting 
Chapter 150B of the General Statutes. All proposed, ad- 
ministrative rules and amendments filed under Chapter 
150B must be published in the Register. The Register 
will typically comprise approximately fifty pages per 
issue of legal text. 

State law requires that a copy of each issue be pro- 
vided free of charge to each county in the state and to 
various state officials and institutions. The North Carolina 
Register is available by yearly subscription at a cost of 
one hundred and five dollars ($105.00) for 24 issues. 

Requests for subscriptions to the North Carolina 
Register should be directed to the Office of Ad- 
ministrative Hearings, P. O. Drawer 27447, Raleigh, N. 
C. 27611-7447, Attn: Subscriptions. 

ADOPTION, AMENDMENT, AND REPEAL OF 
RULES 

An agency intending to adopt, amend, or repeal a rule 
must first publish notice of the proposed action in the 
North Carolina Register. The notice must include the 
time and place of the public hearing; a statement of how 
public comments may be submitted to the agency either 
at the hearing or otherwise; the text of the proposed 
rule or amendment; a reference to the Statutory 
Authority for the action and the proposed effective date. 

The Director of the Office of Administrative Hearings 
has authority to publish a summary, rather than the 
full text, of any amendment which is considered to be 
too lengthy. In such case, the full text of the rule con- 
taining the proposed amendment will be available for 
public inspection at the Rules Division of the Office of 
Administrative Hearings and at the office of the pro- 
mulgating agency. 

Unless a specific statute provides otherwise, at least 
30 days must elapse following publication of the pro- 
posal in the North Carolina Register before the agency 
may conduct the required public hearing and take ac- 
tion on the proposed adoption, amendment or repeal. 

When final action is taken, the promulgating agency 
must file any adopted or amended rule for approval by 
the Administrative Rules Review Commission. Upon ap- 
proval of ARRC, the adopted or amended rule must be 
filed with the Office of Administrative Hearings. If it 
differs substantially from the proposed form published 
as part of the public notice, upon request by the agen- 
cy, the adopted version will again be published in the 
North Carolina Register. 

A rule, or amended rule cannot become effective 
earlier than the first day of the second calendar month 
after the adoption is filed with the Office of Ad- 
ministrative Hearings for publication in the NCAC. 

Proposed action on rules may be withdrawn by the 
promulgating agency at any time before final action is 
taken by the agency. 

TEMPORARY RULES 

Under certain conditions of an emergency nature, 
some agencies may issue temporary rules. A temporary 
rule becomes effective when adopted and remains in 



effect for the period specified in the rule or 180 days, 
whichever is less. An agency adopting a temporary rul 
must begin normal rule-making procedures on the pe 
manent rule at the same time the temporary rule i 
adopted. 

NORTH CAROLINA ADMINISTRATIVE CODE 

The North Carolina Administrative Code (NCAC) is 
a compilation and index of the administrative rules o: 
25 state agencies and 38 occupational licensing boards 
The NCAC comprises approximately 15,000 letter size 
single spaced pages of material of which approximate- 
ly 35% is changed annually. Compilation and publica- 
tion of the NCAC is mandated by G.S. 150B-63(b). 

The Code is divided into Titles and Chapters. Each 
state agency is assigned a separate title which is fur- 
ther broken down by chapters. Title 21 is designatec 
for occupational licensing boards. 

The NCAC is available in two formats. 

(1) Single pages may be obtained at a minimum 
cost of two dollars and 50 cents ($2.50) for 10 
pages or less, plus fifteen cents ($0.15) per each 
additional page. 

(2) The full publication consists of 53 volumes, 
totaling in excess of 15,000 pages. It is sup- 
plemented monthly with replacement pages. A 
one year subscription to the full publication in- 
cluding supplements can be purchased for 
seven hundred and fifty dollars ($750.00). In- 
dividual volumes may also be purchased with 
supplement service. Renewal subscriptions fo: 
supplements to the initial publication available. 

Requests for pages of rules or volumes of the NCAC 
should be directed to the Office of Administrative 
Hearings. 

NOTE 

The foregoing is a generalized statement of the pro- 
cedures to be followed. For specific statutory language, 
it is suggested that Articles 2 and 5 of Chapter 150B of 
the General Statutes be examined carefully. 

CITATION TO THE NORTH CAROLINA 
REGISTER 

The North Carolina Register is cited by volume, issue, 
page number and date. 1:1 NCR 101-201, April 1, 1986 

refers to Volume 1, Issue 1, pages 101 through 201 of 
the North Carolina Register issued on April 1, 1986 



North Carolina Register. Published bi-monthly by the 
Office of Administrative Hearings, P.O. Drawer 27447, 
Raleigh, North Carolina 27611-7447, pursuant to 
Chapter 150B of the General Statutes. Subscriptions 
one hundred and five dollars ($105.00) per year. 

North Carolina Administrative Code. Published in 
looseleaf notebooks with supplement sen-ice by the 
Office of Administrative Hearings, P.O. Drawer 27447, «. I 
Raleigh, North Carolina 27611-7447, pursuant to ^| 
Chapter 150B of the General Satutes. Subscriptions 
seven hundred and fifty dollars ($750.00). Individual 
volumes available. 



NORTH 
CAROLINA 
REGISTER 



ISSUE CONTENTS 




Office of Administrative Hearings 

P. O. Drawer 27447 

Raleigh, NC 27611-7447 

(919) 733 - 2678 



I. EXECUTIVE ORDERS 

Executive Orders 135-138 45 



II. FINAL DECISION LETTER 

Voting Rights Act 48 



III. PROPOSED RULES 

Environment, Health, and 
Natural Resources 

Wildlife Resources 

Commission 84 

Human Resources 

Aging, Division of 72 

Mental Health, Developmental 
Disabilities and Substance 

Abuse Services 49 

Insurance 

Special Services Division 84 

Secretary of State 
Securities Division 85 



Julian Mann III, 

Director 
James R. Scarcella Sr., 

Deputy Director 
Molly Masich, 

Director APA Services 



Staff: 

Ruby Creech, 

Publications Coordinator 
Teresa Kilpatrick, 

Editorial Assistant 
Jean Shirley, 

Editorial Assistant 



IV. FLNAL RULES 
Correction 

Division of Prisons 87 

List of Rules Codified 89 

V. ARRC OBJECTIONS 93 

VI. RULES LNVALIDATED BY 

JUDICIAL DECISION 96 

VII. CUMULATIVE INDEX 98 



NORTH CAROLINA REGISTER 

Publication Schedule 

(April 1991 - December 1992) 



Issue 


Last Day 


Last Day 


Earliest 


* 


Date 


for 


for 


Date for 


Earliest 




Filing 


Electronic 


Public 


Effective 






Filing 


Hearing & 
Adoption by 
Agency 


Date 


******** 


******** 


******** 


******** 


******** 


04/01/91 


03/11/91 


03/18/91 


05/01/91 


08/01/91 


04/15/91 


03/22/91 


04/01/91 


05/15/91 


08/01/91 


05/01/91 


04/10/91 


04/17/91 


05/31/91 


09 '01/91 


05/15/91 


04/24/91 


05/01/91 


06/14/91 


09/01/91 


06/03/91 


05/10/91 


05/17/91 


07/03/91 


10/01/91 


06/14/91 


05/23/91 


05/31/91 


07/14/91 


10 01/91 


07/01/91 


06/10/91 


06/17/91 


07/31/91 


11/01/91 


07/15/91 


06/21/91 


06/28/91 


08/14/91 


11/01/91 


08/01/91 


07/11/91 


07/18/91 


08/31/91 


12/01/91 


08/15/91 


07/25/91 


08/01/91 


09/14/91 


12/01/91 


09/03/91 


08/12/91 


08/19/91 


10/03/91 


01/01/92 


09/16/91 


08/23/91 


08/30/91 


10/16/91 


01/01/92 


10/01/91 


09/10/91 


09/17/91 


10/31/91 


02/01/92 


10/15/91 


09/24/91 


10/01/91 


11/14/91 


02/01/92 


11/01/91 


10/11/91 


10/18/91 


12/01/91 


03/01/92 


11/15/91 


10/24/91 


10/31/91 


12/15/91 


03/01/92 


12/02/91 


11/07/91 


11/14/91 


01/01/92 


04/01/92 


12/16/91 


11/21/91 


12/02/91 


01/15/92 


04/01/92 


01/02/92 


12/09/91 


12/16/91 


01/31/92 


05/01/92 


01/15/92 


12/20,91 


12/31/91 


02/14/92 


05 01/92 


02/03/92 


01/10,92 


01/17/92 


03/04/92 


06 01/92 


02/14/92 


01/24/92 


01/31/92 


03/15/92 


06 01 92 


03/02/92 


02/10/92 


02/17/92 


04/01/92 


07/01/92 


03/16/92 


02/24/92 


03/02/92 


04/15/92 


07/01/92 


04/01/92 


03/11,92 


03/18/92 


05/01/92 


08 01/92 


04/15/92 


03/25/92 


04/01/92 


05/15/92 


08/01/92 


05/01/92 


04/10/92 


04/17/92 


05/31/92 


09 01/92 


05/15/92 


04/24/92 


05/01/92 


06/14/92 


09 01/92 


06/01/92 


05/11/92 


05/18/92 


07,01/92 


10 01 92 


06/15/92 


05/25/92 


06/01/92 


07/15/92 


10 01/92 


07/01/92 


06/10/92 


06/17/92 


07/31/92 


11/01/92 


07/15/92 


06/24/92 


07/01/92 


08/14/92 


11/01/92 


08/03/92 


07/13.92 


07/20/92 


09/02/92 


12/01/92 


08/14/92 


07/24/92 


07/31/92 


09/13/92 


12 0192 


09/01/92 


08/11,92 


08/18/92 


10/01/92 


01 0193 


09/15/92 


08/25,92 


09/01/92 


10/15/92 


01/01/93 


10/01/92 


09/10/92 


09/17/92 


10/31/92 


02 01/93 


10/15/92 


09/24/92 


10/01/92 


11/14/92 


02/01/93 


11/02/92 


10/12/92 


10/19/92 


12/02/92 


03 01 93 


11/16/92 


10/23-92 


10/30/92 


12/16/92 


03 01/93 


12/01/92 


11/06/92 


11/13/92 


12/31/92 


04 01 93 


12/15/92 


11/24/92 


12/01/92 


01/1493 


04 01/93 



* The "Earliest Effective Date" is computed assuming that the public hearing 
and adoption occur in the calendar month immediately following the "Issue 
Date", that the agency files the rule with The Administrative Rules Review 
Commission by the 20th of the same calendar month and that ARRC approves 
the rule at the next calendar month meeting. 



EXECUTIVE ORDERS 



EXECUTIVE ORDER NUMBER 135 

RESCISSION OF EXECUTIVE ORDERS 

NUMBER 88 AND NUMBER 102 

COLUMBUS VOYAGES QUINCENTENARY 

COMMISSION 

By the authority vested in me as Governor by 
the Constitution and laws of North Carolina, IT 
IS ORDERED: 

The Columbus Voyages Quincentenary Com- 
mission is hereby dissolved, and Executive Or- 
ders Number 88 and Number 102 are hereby 
rescinded. 

This order shall be effective immediately. 

Done in Raleigh, North Carolina this the 19th 
day of March, 1991. 

EXECUTIVE ORDER NUMBER 136 
ESTABLISHING THE NORTH CAROLINA 

ADVISORY COUNCIL ON 
TELECOMMUNICATIONS IN EDUCATION 

WHEREAS, to solve the problems of education 
we must use all available resources and technol- 
ogies to their fullest extent; and 

WHEREAS, the use of telecommunications can 
rapidly increase our ability to reach those in need 
of special courses and technical training; and 

WHEREAS, the educational problems in our 
State require that educators develop or coordi- 
nate a plan for the use of telecommunications; 

THEREFORE, by the authority vested in me as 
Governor by the Constitution and Laws of 
North Carolina, IT IS ORDERED: 

Section 1. Establishment. There is hereby es- 
tablished the North Carolina Advisory Council 
on Telecommunications in Education. 

Section 2. Membership. The Advisory Council 
shall be composed of the following members: 

1. The President of the University of North 
Carolina System; 

2. The President of the Department of Com- 
munity Colleges; 

3. The Superintendent of the Department of 
Public Instruction; 

4. The Secretary of the Department of Ad- 
ministration; 



5. The Secretary of the Department of Cor- 
rection; 

6. The Senior Education Advisor to the Gov- 
ernor; 

7. The Education Advisor to the Governor; 

8. The State Controller; and 

9. The President of the Microelectronics Center 
of North Carolina. 

Any member may designate a representative to 
participate in Advisory Council business in the 
event that such member is unable to participate 
in person. 

The Advisory Council may call upon experts in 
the fields of education and telecommunications 
for information and advice. 

Section 3. Chairman and Meetings. The Sec- 
retary of the Department of Administration shall 
serve as Chairman. The Advisory Council shall 
meet at least once per quarter at the call of the 
Chairman. 

Section 4. Purposes. The Advisory Council 
shall perform the following duties: 

a. develop a long-range plan to be presented to 
the Governor for the use of technology in 
public schools, universities, community col- 
leges, homes, and prisons across the State; 
and 

b. coordinate efforts for the efficient use of 
telecommunications in education. 

Section 5. Administrative Support and Ex- 
penses. Administrative support for the Advisory 
Council shall be provided by the Office of the 
Governor. No member shall be entitled to a per 
diem allowance. Reimbursement for actual ex- 
penses may be paid out of funds appropriated to 
the Office of the Governor. 

Section 6. Semiannual Reports. The Advisory 
Council shall submit a semiannual report to the 
Governor on its findings and progress. 

Section 7. Effective Date and Expiration. This 
Executive Order shall be effective immediately 
and shall expire two years from this date, unless 
amended or extended by further Executive Order 
of the Governor. 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



45 



EXECUTIVE ORDERS 



Done in Raleigh, North Carolina, this the 20th 
day of March, 1991. 

EXECUTIVE ORDER NUMBER 137 

ESCROWING CONTRIBUTIONS TO THE 

TEACHERS' AND STATE EMPLOYEES' 

RETIREMENT SYSTEM 

Shortfalls and possible shortfalls in the State's 
revenue collections for fiscal year 1990-91, re- 
quire that the State conserve its cash resources 
whenever the same can be done without impair- 
ing either the services rendered by the State or the 
compensation paid to the State's employees who 
render the services. 

Appropriated but unpaid contributions to the 
Teachers' and State Employees' Retirement Sys- 
tem are authorized contributions by the State to 
the System but are not "funds" of the Teachers' 
and State Employees' Retirement System, as that 
word is used in Article V, Sec. 6(2) of the Con- 
stitution. Like other appropriations, appropri- 
ations to the Teachers' and State Employees' 
Retirement System are subject to the directive 
given the Governor by Article III, Sec. 5(3) of the 
Constitution, to avoid deficits by effecting econ- 
omies in State expenditures. 



the State to members of the Teachers' and State 
Employees' Retirement System for the months 
of January through June, 1991. If and at such 
time prior to June 30, 1991, it is found necessary 
to use some or all of the cash so escrowed to 
keep the State from incurring a deficit as defined 
in Article III, Sec. 5(3) of the Constitution, so 
much of the escrowed cash as shall be needed 
therefor shall be transferred to the General Fund. 
All cash remaining in the Escrow Fund on June 
30, 1991, if any, shall be paid to the Trustees of 
the Teachers' and State Employees' Retirement 
System before the close of that business day as 
the State's contribution to the Fund for the pe- 
riod January 1 through June 30, 1991. 

Section 3^ This Executive order shall be effec- 
tive immediately and remain in effect until 
rescinded or the beginning of the business day 
July 1 , 1991, whichever is earlier. 

Done in Raleigh, North Carolina this 22nd day 
of March, 1991. 

EXECUTIVE ORDER NUMBER 138 
AMENDING EXECUTIVE ORDER NUMBER 137 

Section _L Executive order No. 137 is amended 
to read as follows: 



Actuarial studies based on assumptions that I 
fmd acceptable show that the amounts of the 
State's past contributions to the Teachers' and 
State Employees' Retirement System have been 
such that the State's contributions to the System 
for the months of January through June, 1991, 
can be foregone without impairing cither the 
current of future retirement, disability or death 
benefits to which retirees are entitled under pres- 
ent law. 

THEREFORE, to the end that the State's cash 
resources may be sufficient to meet the State's 
needs for cash for the balance of FY 1990-91 and 
pursuant to authority granted to me bv Article 
III, Sec. 1 and 5(3) of the Constitution, N.C.G.S. 
§§143A-4 and §§143B-4 and the Executive Budget 
Act, it is ORDERED: 

Section _L The State's agencies shall not make 
contributions to the Teachers' and State Em- 
ployees' Retirement System for the months of 
January through June 1991. 

Section 2^ The Office of State Budget and 
Management shall escrow in a special account 
within the Treasury, cash in an amount equal to 
2.3% and 0.16% of the compensation paid by 



"EXECUTIVE ORDER NO. 137 
ESCROWING CONTRIBUTIONS TO THE 
TEACHERS' AND STATE EMPLOYEES- 
RETIREMENT SYSTEM 

"Shortfalls and possible shortfalls in the State's 
revenue collections for fiscal year 1990-91, re- 
quire that the State conserve its cash resources 
whenever the same can be done without impair- 
ing either the services rendered by the State or the 
compensation paid to the State's employees who 
render the services. 

"Appropriated but unpaid contributions to the 
Teachers' and State Employees' Retirement Sys- 
tem are authorized contributions by the State to 
the System but are not 'funds' of the Teachers' 
and State Employees' Retirement System, as that 
word is used in Article V, Sec. 6(2) of the Con- 
stitution. Like other appropriations, appropri- 
ations to the Teachers' and State Employees' 
Retirement System are subject to the directive 
given the Governor by Article III, Sec. 5(3) of the 
Constitution, to avoid deficits by effecting econ- 
omies in State expenditures. 

"Actuarial studies based on assumptions that I 
fmd acceptable show that the amounts of the 



46 



6:2 NORTH CAROLINA REGISTER April 15, 1 99 1 



EXECUTIVE ORDERS 



State's past contributions to the Teachers' and 
State Employees' Retirement System have been 
such that the State's contributions to the System 
for the months of January through June, 1991, 
may be reduced as hereinafter provided without 
impairing either the current or future retirement, 
disability or death benefits to which retirees are 
entitled under present law. 

"THEREFORE, to the end that the State's cash 
resources may be sufficient to meet the State's 
needs for cash for the balance of FY 1990-91 and 
pursuant to authority granted to me by Article 
III, Sees. 1 and 5(3) of the Constitution, 
N.C.G.S. §§143A-4 and §§143B-4 and the Exec- 
utive Budget Act, it is ORDERED: 

"Section L If hereafter found by me to be 
necessary to enable the State to meet its needs for 
cash for the remainder of FY 1990-91 and 
thereby avoid a deficit as defined in Article III, 
Sec. 5(3) of the Constitution, the State's agencies' 
contributions to the Teachers' and State Em- 
ployees' Retirement System for the months of 
January through June 1991, shall be reduced as 
provided in Section 2, hereof. 

"Section 2. JTie Office of State Budget and 
Management shall escrow cash in an amount 
equal to 2.3% and 0.16% of the compensation 
paid by the State to members of the Teachers' 
and State Employees' Retirement System for the 
months of January through June, 1991. If and 



at such time prior to June 30, 1991, it is found 
by me to be necessary to use some or all of the 
cash so escrowed to keep the State from incurring 
a deficit as defined in Article III, Sec. 5(3) of the 
Constitution, so much of the escrowed cash as 
shall be needed therefor shall be transferred to the 
General Fund. All cash remaining in the Escrow 
Fund on June 30, 1991, if any, shall be paid to 
the Trustees of the Teachers' and State Employ- 
ees' Retirement System before the close of that 
business day as the State's contribution to the 
Fund for the period January 1 through June 30, 
1991. 

"Section 3^ This Executive Order shall be ef- 
fective immediately and remain in effect until 
rescinded or the beginning of the business day 
July 1, 1991, whichever is earlier. 

Done in Raleigh, North Carolina this 22nd day 
of March, 1991." 



Section 2. 



Executive Order No. 137, as 



amended, is republished and reaffirmed in its en- 
tirety. 

Section 3^ This Executive Order is effective im- 
mediately. 

Done in Raleigh, North Carolina this 28th day 
of March, 1991. 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



47 



VOTING RIGHTS ACT FINAL DECISION LETTER 



[G.S. 1 20-30.9H, effective July 16, 1986, requires that all letters and other documents issued by the 
A ttorney General of the United States in which a final decision is made concerning a "change af- 
fecting voting" under Section 5 of the Voting Rights Act of 1965 be published in the North Carolina 
Register. / 



U.S. Department of Justice 
Civil Rights Division 

JRD:MAP:TGL:rac 

DJ 166-012-3 Voting Section 

91-0116 P.O. Box 66128 

Washington, D.C. 20035-6128 



March 4, 1991 



DeWitt F. McCarley, Esq. 
City Attorney 
P. 5. Box 7207 

Greenville, North Carolina 27835-7207 

Dear Mr. McCarley: 

This refers to the four annexations [Ordinance Nos. 2258, 2259, 2260 and 2261 (1990)] and the 
designation of the annexed areas to districts for the City of Greenville in Pitt County, North Carolina, 
submitted to the Attorney General pursuant to Section 5 of the Voting Rights Act of 1965, as amended, 
42 U.S. C. 1973c. We received your submission on January 15, 1991. 

The Attorney General does not interpose any objection to the specified changes. However, we 
note that Section 5 expressly provides that the failure of the Attorney General to object does not bar 
subsequent litigation to enjoin the enforcement of the changes. See the Procedures for the Adminis- 
tration of Section 5 (28 C.F.R. 51.41). 

Sincerely, 

John R. Dunne 

Assistant Attorney General 

Civil Rights Division 



By: 



J. Gerald Hebert 
Acting Chief, Voting Section 



48 6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



TITLE 10 - DEPARTMENT OF HUMAN 
RESOURCES 

iV otice is hereby given in accordance with G.S. 
I SOB- 1 2 that the Commission for Mental Health, 
Developmental Disabilities and Substance Abuse 
Services intends to amend rule(s) cited as 10 
NCAC 14K .0103, .0314 - .03/5; 18L .1522. 

1 he proposed effective date of this action is Oc- 
tober 1, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on May 15, 1991 at the Archdale Building, 
512 N. Salisbury St., Raleigh, NC 27604-1159, 
Public Hearing Room - Ground Floor. 

K^omment Procedures: Any interested person 
may present his comments by oral presentation or 
by submitting a written statement. Persons wish- 
ing to make oral presentations should contact 
Marilyn Brothers, Division of Mental Health, De- 
velopmental Disabilities and Substance Abuse 
Services, 325 N. Salisbury St., Raleigh, NC 
27603, (919) 733-4774 by May 14, 1991. Written 
comments must be sent to the above address and 
must state the rule(s) to which the comments are 
addressed. Fiscal information on these rules is 
also available from the same address. 

CHAPTER 14 - MENTAL HEALTH: GENERAL 

SLBCHAPTER 14K - CORE LICENSLRE RLLES 

FOR MENTAL HEALTH: MENTAL 

RETARDATION AND OTHER 

DEVELOPMENTAL DISABILITIES: AND 

SLBSTANCE ABLSE FACILITIES 

SECTION .0100 - GENERAL INFORMATION 

.0103 DEFINITIONS 

(c) The following terms shall have the 
meanings specified: 

(11) "Atypical development" in children 
means those from birth to 60 months of 
age who demonstrate significantly atypical 
behavioral socioemotional, motor, or 
sensory development as manifested by: 

(A) Diagnoood diagnosed hyperactivity, at- 
tention deficit disorder or other behavioral 
disorders; or 

(B) Identified identified emotional or be- 
havioral disorders such as: 

(i) delay or abnormality in achieving ex- 
pected emotional milestones, such as 
attachment, parent-child interaction, 
pleasurable interest in adults and peers, 



ability to communicate emotional 
needs, and ability to tolerate frus- 
trations; 
(ii) persistent failure to initiate or respond 

to most social interactions; 
(iii) fearfulness or other distress that does 
not respond to comforting by 
caregivers; 
(iv) indiscriminate sociability, e.g. exces- 
sive familiarity with relative strangers; 
or 
(v) self-injurious or unusually aggressive 
behavior; or 
(C) Substantiated substantiated physical 
abuse, sexual abuse, or other environ- 
mental situations that raise significant 
concern regarding the child's emotional 
well-being. 
(23) "Developmentally delayed children" 
means those whose development is de- 
layed in one or more of the following 
areas: cognitive development, physical de- 
velopment, including vision and hearing, 
language or speech, self-help and 
psychosocial skills. The specific level of 
delay must be: 

(A) for children from birth to 36 months 
of age, documented by scores -H-*- one 
and one-half standard deviations below 
the mean on standardized tests in at least 
one of the above areas of development. 
Or, it may be documented by a 20 percent 
delay on assessment instruments that yield 
scores in months; and 

(B) for children from 36 to 60 months of 
age, documented by test performance two 
standardis e d standard deviations below 
the mean on standardized tests in one area 
of development or by performance that is 
one standard deviation below the norm in 
two areas of development. Or, it may be 
documented by a 25 percent delay in two 
areas on assessment instruments that yield 
scores in months. 

(39) "High risk children" means those from 
birth to 36 months of age who: 

(A) have a diagnosed physical ©f mental 
condition which hr» a hieh probability ef 
resulting i» developmental delay ef atypi 
eal development; 

(-8+ have significant atypical patterns ef de- 
velopmont (perceptual, sensory, physical, 
behavioral, motor anomali e s) that- have a 
high probability ef resulting » d e v e lop 
mental delay &f atypical development; e* 

(-G+ have respond e d weli te- intervention ef- 
forts b«t- fof whom there k e vid e nced that- 
their continued developmental progress 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



49 



PROPOSED RULES 



cannot be assured without continued 
intervention. 

for whom there is clinical evidence of 
conditions which have a high probability 
of resulting in developmental delay or 
atypical development and for whom there 
is clinical evidence that developmental or 
therapeutic intervention may be necessary'. 
There are two categories of high risk chil- 
dren. These are: 
(A) High Risk-Established: Diagnosed or 
documented, physical or mental condi- 
tions, which are known to result in devel- 
opmental delay or atypical development 
as the child matures. Such conditions are 
limited to the following: 
(1) chromosomal anomaly or genetic dis- 
orders associated with developmental 
deficits; 
(ii) metabolic disorders associated with 



developmental deficits; 
(iu) infectious diseases associated 

developmental deficits; 
(iv) neurologic disorders; 
(v) congenital malformations; 
till 



with 



sensory disorders; or 
(vii) toxic exposure. 
(B) High Risk-Potential: 



Documented 



presence of indicators which are associ- 
ated with patterns of development and 
which have a high probability of meeting 
the criteria for developmental delay or 
atypical development as the child matures. 
There shall be documentation of at least 
three of the parental or family, neonatal, 
or postneonatal nsk conditions as defined 
in the publication. "NORTH 

CAROLINA CHILD SERVICE CO- 
ORDINATION PROGRAM" available 
from the Division of Maternal and Child 
Health, Department of Environment, 
Health, and Natural Resources. PO Box 



27687, Raleigh, 



in accordance 



NC 27611-7687, adopted 
with G.S. 150B- 14(c). 



These conditions are as follows: 



(i) maternal age less than 1 5 years; 

( ii ) maternal PKL ; 

(hi) mother II IV positive; 

(iv) maternal use of anticonvulsant, 



antineoplastic or anticoagulant drugs; 
(v) parental blindness; 
(vi) parental substance abuse; 
(vii) parental mental retardation; 
(viii) parental mental illness; 
( ix ) difficulty in bondmg between parent 

and infant; 
(x) difficulty in providing basic parenting; 
(xi) lack of stable housing; 



(xii) lack of familial and social support; 
(xiii) family history of childhood 

deafness; 
(xiv) maternal hepatitis Bj 
(xv) birth weight less than 1 500 grams; 
(xvi) gestational age less than 32 weeks; 
(xvii) respiratory distress (mechanical 

ventilator greater than six hours); 
(xviii) asphyxia; 

(xix) hypoglycemia (less than 25 mg/dl); 
(xx) hyperbilirubinemia (greater than 20 

mg'dl); 
(xxi) intrac ranial hemorrhage; 



(xxii) neonatal seizures; 

(xxiii) 

( xxiv ) 

(xxv 



major congenital anomalies; 
CNS infection or trauma; 



congenitally acquired infection; 
suspected visual impairment; 
suspected hearing impairment; 
xxvui) no well child care by age 



( xxvi ) 
( xxvii 



SIX 



months; 



(xxix) failure on standard developmental 

or sensory screening test; 
(xxx) significant parental concern; and 
(xxxi) suspected abuse or neglect. 

Statutory Authority G.S. 122C-26; 130A-I44; 
1 30 A- 1 52; 143B-I47. 

SECTION .0300 - FACILITY AND PROGRAM 
MANAGEMENT 

.0314 ASSESSMENT 

(a) The governing body shall develop written 
policies and procedures relative to assessment re- 
quirements for individuals served by the facility. 

(b) Mental Health Facilities: 

(1) Inpatient psychiatric, residential acute 
treatment, partial hospitalization, residen- 
tial treatment for children and youth, and 
day treatment facilities for children and 
youth shall complete: 

(A) Aft an individual admission assessment 
within 24 hours of admission, including 
mental status, admitting diagnosis, and 
determination of need for additional in- 
formation, diagnostic tests or evaluations; 

(B) A a preliminary individual treatment 
plan within 72 hours of admission; and 

(C) Current current social, medical, psychi- 
atric, educational and vocational histories 
and assessments such as substance abuse, 
developmental, legal, nutritional, etc., 
completed or obtained within 30 days, if 
appropriate. 

(2) Psychosocial rehabilitation programs and 
group homes for adult and elderly clients 
shall complete an admission note within 



50 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



24 hours for each client who is admitted 
to the facility. The admission note shall 
include the present condition of the client 
reported in objective, behavioral terms; 
the name of the mental health profes- 
sional who is responsible for the treatment 
and case management of the client; and 
the reason for admission, 
(c) Developmental Disabilities Facilities and 
Sheltered Workshops: 

(1) Within 30 days following admission, the 
following assessment information shall be 
completed: 

(A) the present condition of the client re- 
ported in objective, behavioral terms, and 
where possible a description of the client's 
condition by family members; Fef aH fa- 
cilities serving infants, toddlers a«d pfe- 
school age children, oxcopt those 
providing respit e services, the assessment 
ef levels ef physical, including vision a«d 
hearing, languag e a«4 cpooch, cognitive, 
psychosocial a«d self help skill o dovolop 
mont shall be completed. There shall be 
a determination »f the child's unique 
needs m terms ef these areas »f develop 
mont a«d identification e£ services appro 
priate t» me e t those needs. Also, fof all 
faciliti e s s e rving infants, toddlers asd 
preschoolers oxcopt fef roopito, the ausoso 
mont process shall include, if the family 

LH^ UV31Tv3y ~ UVIL'I lllllllll IT7I I Ul I I ITJ DRVRCI II J 

and needs »f the family related to en- 
hancing the development ef the child. 
T-he family focused assessment shall be 
based ©» information provided through a 
personal intervi e w and incorporate the 
family's d e scription »f the strengths a«4 
noods. The assessment process shall ift- 
cludo procoduros fof ensuring partic 
ipation by- the cli e nt's family »f the legally 
rosponsiblo p e rson; 

(B) social, developmental and medical his- 
tories and assessments. Additional histo- 
ries and assessments shall be completed 
as appropriate (e.g., vocational, psychiat- 
ric, legal, educational and nutritional). 
Histories and assessments generated by 
other facilities or service providers may be 
used for respite programs; 

(C) determination of, and request for, ad- 
ditional referrals for special diagnostic 
tests, assessments or evaluations, if 
needed; 

(D) results of other standardized and non- 
standardized evaluations in the areas 
identified in Subparagraph (c)(1)(B) of 
this Rule; 



(E) summary of client and, if appropriate, 
family strengths and weaknesses; 

(F) copies of relevant evaluations from 
other agencies or service providers. 

(2) An ADAP which operates within a shel- 
tered workshop that meets the require- 
ments of the Division of Vocational 
Rehabilitation Services shall be considered 
to have an approved ADAP evaluation 
program which may provide the informa- 
tion for the evaluation report. 

(3) No more than 30 days prior to admission 
to a facility, a medical assessment shall be 
completed indicating the client's ability to 
participate in the program, presence of a 
communicable disease or a communicable 
condition that presents a significant risk 
for transmission within the facility, and 
compliance with the immunization re- 
quirements in G.S. 130A-152. If the cli- 
ent has specific medical problems, the 
physician's assessment shall include a 
written statement regarding management 
of the client, including control measures 
required for communicable diseases and 
conditions by G.S. 130A-144. The phy- 
sician's assessment shall be updated at 
least annually during the client's place- 
ment in the facility except for ADAP, al- 
ternative family living and supervised 
independent living. 

f4) -F-»f all facilitios serving infants, toddlers 
aftd- preschoolers except fof rospito: 

/^^^\ t^^^^^^ ^^Q^i ' * * * fc ' **~ ■ >' r ' I I I I'll t j XT \ *J^^^^^^*~^^^^& ^^^^A 

y I I J IT. "'I O til HI rTTTTCT CTTS.I Till I IT 7 I 1 I F IT-I I \J I 1 III O til 1U 

procedures shall be administered m the 
native language »f the parents &f other 
mode »f communication unless & » 
clearly ftet- feasible te» de- s»f 
(4£) any assessment proc e dur e s and matori 
als that- are used a*e selected a»d ad minis 
terod se- as net- te> be racially ef culturally 
discriminatory; 

if \ nn rMi(iLi rirfi /'iifl 1 1 ra l - \-i ■ i 1 1 t^^ I 1 t'i W 1 'I f' t I 1 i *| 

sele criterion for dotonnining » child's el- 
igibility under this part; 
(-Df assessm e nts shall be carried »«t by 
professionals privileged according te- pro 
ceduros outlined i» the Division's pubh 
cation, "REGULATIONS EOR- 

PRIVIIEGING PROFESSIONALS 

WORKING WITH INFANTS AXD 

rnnni rpt witi i pp at p icy t:r>r> 

developmental delay 044 
atypical development", apsm 

4-2&-4 (01/01/89) w comparable proco 
dur e s approved by the Division; 
(-&} the assessment process shall be a 
multidisciplinary »ee a«d reflect the «- 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



51 



PROPOSED RULES 



volvc - mont ef twe e? more disciplines ef 
professions with the specific number a«4 
types ȣ disciplines det e rmin e d by- the 
needs »t the particular child; 
(4*4- *be evaluation process must be baood 

e» informod clinical opinion; 
$G) tbe assessment process shall be com 
plotod within -14 cal e ndar days from the 
date ei referral; a«4 
f44} the child's family ©f legally responsible 
person shall be fully informed ef the Fe- 
sults e4 the assessment proc e ss. 
(d) For all facilities serving infants and toddlers 
with or at nsk for developmental disabilities, de- 
lavs or atypical development, except for respite, 
there shall be: 

an assessment of levels of physical, (in- 
cluding vision and hearing I, language and 
speech, cognitive, psychosocial and self- 
help skills development: 



in 



(2) a determination of the child's unique 
needs in terms of these areas of develop- 
ment and identification of services appro- 
pnate to meet those needs; 

(3) if requested bv the family, a determination 
of the strengths and needs of the family 
related to enhancing the development of 
the child. The family focused assessment 
shall be based on information provided 
through a personal interview and incor- 
porate the family's description of the 



strengths and needs; 



(4) 



procedures developed and implemented 
to ensure participation bv the client's 
family or the legally responsible person; 

(5) tests and other evaluation materials and 
procedures administered in the native lan- 
guage of the parents or other mode of 
communication unless it is clearlv not 
feasible to do so^ 

(6) assessment procedures and materials 
which are selected and administered so as 
not to be racially or culturally 
discriminatory; 

(7) no single procedure used as the sole cri- 
terion for determining a child's eligibility 
under this Paragraph; 

(S) an integrated assessment process which 
involves at least three persons, each re- 
presenting a different discipline or profes- 
sion, with the specific number and tvpe: 
ot disciplines based on the particular 
needs of the child. One of the disciplines 
shall include a physician. ph\ sician s as- 
sistant or nurse practitioner: 

19) an evaluation process based on informed 
clinical opinion: 



( 1 ) an assessment process completed within 
45 calendar days from the date of referral. 
The referral is initiated by a written re- 
quest for these services made to any one 
of the public agencies participating in the 
PL 99-457 Interagency Agreement. The 
request becomes a referral when the area 
program determines that all of the fol- 
lowing is available: 

( A j the family's written consent to receive 
this service; 

(B) sufficient background information to 
enable the agency receiving the referral to 
establish communication through a tele- 
phone call or home visit; 

(C) reason for referral, date of referral and 
agency or individual making referral: 

( D) child and family identifying information 
such as names, child s birthdate and pri- 
mary physician; and 

(E) summary of anv pre-existing child and 
family screening or assessment informa- 
tion; 

(11) a 45 calendar day completion require- 
ment which may be extended in excep- 
tional circumstances, such as, the child's 
health assessment is being completed out- 
of-state, or family desires make it impos- 



!l. 



sible to complete the assessment within 
the time period. The specific nature and 
duration of these circumstances which 
prevent completion within 45 davs and 
the attempts made bv the provider to 
complete the assessment shall be docu- 
mented; and 

the child's family or legally responsible 
person shall be fully informed of the re- 
sults of the assessment process, 
(e) (4+ Substance Abuse Facilities: 
(1) Substance abuse facilities, with the ex- 
ception of supervised independent living, 
alternative family living and halfway 
houses, shall conduct an assessment of the 
client after admission as follows: 

(A) admission assessment to be done within 
24 hours of admission which includes 
reason for admission, mental status in- 
cluding suicide potential, admitting diag- 
nosis, medical history and general physical 
condition, activities assessment, history of 
or assessment of potential for physical 
abuse of family members or others, a 
family assessment when minors are 
served, legal status and substance use his- 
tory; 

(B) in inpatient hospital treatment, resi- 
dential treatment or rehabilitation, non- 
hospital medical detoxification, and 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



outpatient detoxification facilities, a med- 
ical examination shall be completed 
within 24 hours of admission; and 
(C) except in detoxification facilities, his- 
torical material including social, legal, 
psychiatric, educational and vocational 
assessments shall be completed within 30 
days of admission. 
(2) In halfway houses, a thorough review 
shall be made to determine appropriate- 
ness of continued service in the facility 
within 30 days of admission and at least 
every three months thereafter. 
(f) (e) Faculties Serving .More Than One Disa- 
bility (except for sheltered workshops): 

(1) An admission note shall be completed for 
each client within 24 hours of admission 
which includes at least the following: 

(A) the present condition of the client re- 
ported in objective, behavioral terms; 

(B) the reason for admission; and 

(C) the name of the qualified mental health 
professional, qualified developmental dis- 
abilities professional or qualified sub- 
stance abuse professional as appropriate, 
who has designated responsibility for the 
client's treatment, program or case man- 
agement plan. 

(2) The facility shall obtain assessment in- 
formation judged to be essential to serving 
the client in the facility, from the qualified 
mental health professional, qualified de- 
velopmental disabilities professional or 
qualified substance abuse professional 
who has designated responsibility for the 
client's treatment, program or case man- 
agement plan. 

(3) Any other assessment information re- 
quired by the facility's own policies shall 
be completed or obtained as required by 
those policies. 

Statutory Authority G.S. I22C-26; 130 A- 144; 
130 A- 1 '52; 143B-147. 

.0315 INDIVIDUAL TREATMENT/PROGRAM 
PLAN 

(a) The governing body shall have written 
policies and procedures for the development of 
individual treatment and program plans and the 
assignment of staff responsibilities for implemen- 
tation of such plans. 

(b) Individual plans for each client shall be 
based upon an evaluation of the client's condi- 
tion, assets and needs and the resources to meet 
these needs. This plan shall provide a systematic 
approach to the treatment/habilitation of the cli- 
ent and substantiate the appropriateness of the 



treatment or habilitation goals. The plan shall 
be developed in partnership with the client or 
individual acting in behalf of the client. Clinical 
responsibility for the development and imple- 
mentation of the plan shall be designated, 
(c) Mental Health Facilities: 

(1) Inpatient psychiatric, residential acute 
treatment, partial hospitalization, residen- 
tial treatment for children and youth, and 
day treatment for children and youth fa- 
cilities shall comply with the following 
requirements: 

(A) A comprehensive treatment plan, based 
on information gathered during the as- 
sessment process, shall be developed in 
cooperation with the client and imple- 
mented within 30 days of admission, with 
the exception of inpatient psychiatric and 
residential acute treatment facilities 
wherein the plan shall be implemented 
within ten days of admission. The com- 
prehensive plan shall include at least the 
following: diagnosis and time- specific 
short and long-term measurable goals, 
strategies for reaching goals and staff re- 
sponsibility for plan implementation. 

"(B) Progress notes shall be completed on 
at least a weekly basis and reflect the cli- 
ent's progress or lack of progress toward 
meeting goals, staff interventions and in- 
formation which may have a significant 
impact on the client's condition. 

(C) A thorough review of the comprehen- 
sive treatment plan shall be carried out 
and documented in the plan at least every 
six months or more frequently if medically 
or clinically indicated. 

(2) Group homes for adult and elderly indi- 
viduals who are mentally ill shall comply 
with the following requirements: 

(A) Individual client plans shall be devel- 
oped in cooperation with the client, the 
facility staff and the mental health profes- 
sional who is responsible for the treatment 
or case management of the client within 
30 days of the client's admission to the 
facility. The plan shall include at least the 
following: time-specific short and long- 
term goals to be addressed by the client 
and the facility staff; documentation of 
coordination of the plan for the client 
with the comprehensive treatment plan; 
afi4 the designated treatment responsibil- 
ities of the mental health professional 
providing treatment; and the responsibil- 
ities of the facility staff. 

(B) Progress notes shall be completed on a 
monthly basis which reflect the client's 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



53 



PROPOSED RULES 



progress or lack of progress toward meet- 
ing goals; documentation of coordination 
between the facility staff and the mental 
health professional who is responsible for 
treatment; and any other information 
which may have a significant impact on 
the client's condition. 
(C) A thorough review of the plan shall be 
carried out and documented in the plan 
at least annually or more frequently if 
medically or clinically indicated. 

(3) Psychosocial rehabilitation programs shall 
comply with the following requirements: 

(A) A plan shall be developed in cooper- 
ation with the client within 30 days of the 
client's admission to the facility. The plan 
shall include at least the following: 

(i) assessment of the client's strengths and 

weaknesses; 
(ii) individual service goals and activities 

in which the client will participate; and 
(iii I designation of staff responsibility for 

coordination with goals contained in 

the client's comprehensive treatment 

plan. 

( B ) Progress notes shall be completed on a 
monthly basis which document the cli- 
ent s progress toward goal achievement 
and other significant information regard- 
ing the client's situation. 

(C) The plan shall be reviewed and changes 
documented at least every six months or 
more frequently if indicated based on cli- 
ent functioning. 

(4) Any facility which serves individuals on a 
drop-m basis shall maintain a daily at- 
tendance log, a daily activity plan, and 
documentation of referrals to other service 
providers. 

(d) Developmental Disabilities Facilities and 
Sheltered Workshops: 

( 1 1 Individual program plans shall be devel- 
oped and implemented within 30 days of 
admission to all facilities with the excep- 
tion of respite care programs. The plan 
shall be reviewed at least quarterly and 
assessed and redeveloped at least annually. 
For clients in ADAP-facility based models 
and sheltered workshop placements, the 
annual assessment shall include a review 
to determine the need for referral to Vo- 
cational Rehabilitation or other services. 
For clients in ADAP-Supported 
Employment- Long-Term Support, it shall 
include an indication of the level of need 
for long-term support activities and the 
specific type of support required. Pro- 
gram plans shall provide the basis for the 



development of individual goal plans. 
Program plans shall provide a systematic 
approach to the habilitation of the client 
and substantiate the appropriateness of 
the habilitation goals. Program plans 
shall be developed in partnership with cli- 
ents or individuals acting in behalf of cli- 
ents. Clinical responsibility for the 
development and implementation of pro- 
gram plans shall be designated, to addi 
tion, m facilities carving infants, toddlers 
e* preschool age children, oxcopt fof thooo 
providing respite services, tee program 
f4a» » r e ferred to a* tee Individualized 
Family Sorvico Plan (IFSP) a*4 shall m- 
clude: 

fA} a description ef tee child's present lev- 
els ef- physical development, including vi- 
sion. hearing a»4 health status, cognitive 
development, language a*4 spooch dovol 
opment, psycho social development affo 
self help stefe? 

(-B-)- with tee concurrence ef tee family, a 
d e scription ef tee family's str e ngths affo 
needs related te enhancing tee develop 
ment ef tee child; 

(-&} goals fof tee child's family a* well a* 
goals fof tee child: 

fDf criteria affo timeframe te be used te 
determine progress towards goals; 

(-&+ planned habilitation procedures related 
to tee goals; 

(-P4 a statement ef tee specific early inter 
vention services to be provided to meet 
tee identified child a»4 family needs, a«4 
tee initiation dates, frequency affo 
method, duration, intensity a»4 location 
»f service d e livery a«4 tee persons ef 
agencies responsibl e ; 

fG} tee designation e£ tee staff member fe- 
sponsible fof ea^e management services; 

(4-tf tee plans fop transition toto services 
which a*e tee responsibility &£ tee N . C . 
Department ef Public Instruction; 

(-!-)• tee payment arrang e m e nts fof tee sf>e- 
eifre services delineated to Subparagraph 
(d)(1)(F); aad 

(4} a description ef medical a»4 other sef- 
vices teat- tee child needs bto which afe 
ft©4 required under P-ter 99 157 ae4 tee 
strategies to be pursued to secure thos e 
services through public ef private fe- 
sourc e s. 
f4^ The initial development affo annual r e view 
process fof tee FFSP fof infants, toddl e rs 
affo preschoolers shall include partic 
i pation by-r 

(A4 tee parent ef par e nts ef tee child; 



54 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



(©} othor family members, as roquootod by- 
the parent; 

{&} a» advocato »? person outside ef the 
family if the parent requests that the pe?- 
se» participate; 

(©) tbe provider ef tbe e arly intervention 
cervices; 

£E) the 6ase managor designated fef the 
family if difforont; a»4 

(4*) the provider ef the assessment service 
if difforont . 

Tbe quarterly roviow proooss shall include 
participation by p e rsons identified i» 
Subparagraphs (d)(2)(A) through (6)r If 
a»y ef those individuals a*e unable te at- 
tend efte »f the roforoncod development 
et review meetings, arrangements shall be 
mad e fof the person's involvement 
through othor moans ouch as participation 
» a telephone conf e rence 6aHy having a 
knowledgeable authorized representative 
attend the meeting e* making portinont 
records available at- the meeting. 
(44 44>e IFSP fof infants, toddlers a«4 
preschoolers is based upon the results ef 
the assessment referenced » 4-© NCAC 
MK .03M(c). Ilowovor, early inter 
vention Dorvicos may oommonco beforo 
complotion ef this assessment if parental 
consent is obtain e d, the assessment is 
completed within the timo period refer 
e«ee4 m W NCAC 444v .0312( ' 1)(c), a»d 
a» interim IFSP is developed. 44*e i»- 
terim IbSP shall include: 

I A t J_li^ ^wittt^i ■-» f t U.i /"!■', i j v-t .in f fiAi- ii;li^ t 1 r« 1 I 
yT ry I 1 l\J I ECO 1 1*-' » "I 1 1 IV C7ECQC I 1 ECO rCEECT TTTTTT ^X^Er 

be responsible fof the implementation ef 

the IFSP a»4 coordination with other 

agencies aftd individuals; 
(434 Short term quarterly goals fef the child 

aftd- family wh e n recommended; 
(C4 Those early intervention services that 

are needed immediately; a«4 
fD4 Suggested activities that may be carried 

ewt by- the family members. 
(44 Fach facility t»f individual who has a direct 

Fele i» the provision ef early intervention 

services specified i» the IFSP is responoi 

v ' iv i i.'i 1 1 iLin.il ip rr k"vu i on 1 1 ctttttt r * ctowKrt 

e ach e ligibl e child ift achi e ving the goals 
set fertb i» the IFSP. 

(44 44*e tF&P- shaft be developed within 45 
days ef referral fof those children deter 
mined te be eligible 

(2) (64 Individual goal plans shall be developed 
in the appropriate developmental and vo- 
cational skill areas. Goal plans shall be 
assessed on a quarterly basis in all facilities 
with the exception of developmental disa- 



bility and behavior disorder group homes 
wherein goal plans shall be assessed on a 
monthly basis. Such assessment shall ad- 
dress the client's progress or lack of 
progress toward meeting the plan and re- 
view of the plan for appropriateness of 
established goals. Individual goal plans 
are not required for clients in supervised 
independent living, alternative family liv- 
ing, sheltered workshops and ADAP cli- 
ents in supported employment. 
Individual goal plans are also not required 
for ADAP clients targeted for supported 
employment or those in the intensive 
training period or the long-term support 
period of supported employment. To be 
targeted as a supported employment cli- 
ent, the client must have been determined 
in writing to be appropriate for supported 
employment by representatives of the fa- 
cility, the local unit of the Division of 
Vocational Rehabilitation Services and 
the Area Developmental Disabilities Spe- 
cialist of the Area Mental Health, Mental 
Retardation and Substance Abuse Pro- 
gram or his designee. 

(3) (?) In specialized community residential 
centers, nursing care plans shall be devel- 
oped and implemented in addition to the 
individual program plan. The nursing 
care plan must address medical needs and 
nursing care. Such plans shall be inte- 
grated with individual goal plans. 

(4) f&4 In developmental disability and behav- 

ior disorder group homes, the individual 
program plan shall specify a time -specific 
admission of less than six months, to be 
extended as needed on a six-month basis, 
and shall emphasize programming objec- 
tives that assist the client in exiting to a 
less restrictive setting. 

(5) (94 Progress notes shall be completed 
which reflect the client's progress or lack 
of progress toward meeting program plan 
goals, staff interventions and any infor- 
mation which may have a significant im- 
pact on the client's condition. 
Documentation shall be made of any 
conferences or involvements with the cli- 
ent's family or involved agencies. 

(A) Progress notes for respite services shall 
be completed after each respite episode. 

(B) Progress notes for developmental disa- 
bility and behavior disorder group homes 
shall be completed at least monthly. 

(C) Progress notes in all other services shall 
be on at least a quarterly basis. 



6:2 NORTH CAROLINA REGISTER April 15, 1 99 1 



55 



PROPOSED RULES 



(D) Except for respite services, when the 
client is a minor, progress reports regard- 
ing the program plan shall be given to the 
legally responsible person on a quarterly 
basis. 
(e) For all facilities serving infants and toddlers 
with or at risk for developmental disabilities, de- 
lavs or atypical development, except for respite: 
( 1) there shall be a habitation plan which is 
referred to as the Individualized Family 
Service Plan (1FSP) which shall include: 

(A) a description of the child's present lev- 
els of physical (including vision and hear- 
ing), health status, language and speech, 
cognitive, psychosocial, and self-help skills 
development; 

(B) the concurrence of the family, a de- 
scription of the family's strengths and 
needs related to enhancing the develop- 
ment of the child: 

(C) goals for the child, and, if requested, 
goals for the child's family; 

( Di criteria and timeframes to be used to 
determine progress towards goals 



(F) planned habilitation procedures related 
to the goals; 

(F) a statement of the specific early inter- 
vention services to be provided to meet 
the identified child and family needs, the 
initiation dates, frequency and method, 



duration, intensity and location of service 
delivery, and the persons or agencies re- 
sponsible; 

(G) the designation of the staff member re- 
sponsible for service coordination; 

(II) the plans for transition into services 
which are the responsibility of th£ N . C . 
Department of Public Instruction, when 
applicable; 

(1) the payment arrangements for the spe- 
cific services delmeated in Subparagraph 
(e)(1)(F) of this Rule; 

(J) a description of medical and other ser- 
vices needed bv the child, but which are 
not required under PL. 99-457, and the 
strategies to be pursued to secure those 
senices through public or private re- 
sources. 

(2) The IFSP shall be: 

(A) reviewed on at least a semi-annual basis 
or more frequently upon the family's re- 
quest: and 

(B) revised as appropriate, but at least an- 
nually. 

(3) The initial development and annual re- 
vision process for the IFSP for infants, 
toddlers and preschoolers shall include 
participation bv: 



(A) the parent or parents of the child; 

(B) other family members, as requested bv 
the parent; 

(C) an advocate or person outside of the 
family if the parent requests that the per- 
son participate; 

(D) the provider of the early intervention 
senices; 

(F) the service coordinator designated for 
the family, if different from the provider 
of the early intervention services; and 

(F) the provider of the assessment service, 
if different from the provider of the early 
intervention services. 

The semi-annual review process shall in- 
clude participation by persons identified 
jn Subparagraphs (e)(3)(A) through (F) 
of this Rule. If anv of these individuals 
are unable to attend one of the develop- 
ment or review meetings, arrangements 
shall be made for the person s involve- 
ment through other means such as partic- 
ipation jn a telephone conference call, 
having a knowledgeable authorized repre- 
sentative attend the meeting or making 
pertinent records available at the meeting. 
(4) The IFSP for infants, toddlers and 
preschoolers is based upon the results of 
the assessment - referenced in ]_0 NCAC 
14K. .0314(c)(4). However, early inter- 
vention services may commence before 
completion of this assessment if parental 
consent is obtained, the assessment is 
completed within the time period refer- 
enced in 10 NCAC 14K .0314(c)(4). and 
an interim IFSP is developed. Fhe in- 
tenm IFSP shall include: 

( A ) the name of the service coordinator 
who will be responsible for the imple- 
mentation of the IFSP and coordination 
with other agencies and individuals; 



(B) goals for the child and family when re- 
commended; 

(C) those early intervention services that are 
needed immediately; and 

(D) suggested activities that mav be carried 
out by the family members. 

(5) Fach facility or individual who has a direct 
role in the provision of early intervention 
services specified in the IFSP is responsi- 
ble for m along a good faith effort to assist 
each eligible child in achieving the goals 



set forth in the IFSP. 



!£ 



The IFSP shall be developed within 45 
days of referral for those children deter- 
mined to be eligible. The referral shall be 
as defined in 10 NCAC 14K .0314(d)! 1 1 1. 



(f) (e) Substance Abuse Facilities: 



56 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



(1) The preliminary treatment plan or 
detoxification instructions shall be initi- 
ated within 24 hours of admission and 
shall be based upon information gathered 
during the admission assessment. 

(2) The comprehensive treatment plan for 
clients in therapeutic homes and outpa- 
tient treatment facilities shall be imple- 
mented within 30 days of admission. The 
comprehensive treatment plan for clients 
in inpatient hospital treatment programs 
and residential treatment 'habilitation fa- 
cilities shall be implemented within ten 
days of admission. Such plan shall in- 
clude diagnosis, time-specific short and 
long-term measurable goals, and strategies 
for reaching goals. The treatment plan 
shall be reviewed and revised whenever 
medically or clinically indicated or at least 
every six months. 

(3) Progress notes shall be written to reflect 
the client's progress or lack of progress 
toward meeting the treatment plan goals 
and shall reflect staff interventions and 
any information which may have a signif- 
icant impact on the client's status. Doc- 
umentation shall be made of any 
conference or involvements with the cli- 
ent's family or involved agencies and any 
major events related to the client. 

(A) Progress notes in outpatient services, 
including outpatient detoxification ser- 
vices, shall be completed after each client 
visit. 

(B) Progress notes shall be completed 
weekly in residential 
treatment/ habilitation facilities and 
therapeutic homes. 

(C) Progress notes shall be completed on 
each client in social setting and nonhos- 
pital medical detoxification facilities at 
least every eight hours. 

(D) In inpatient hospital treatment facili- 
ties, progress notes shall be completed on 
each shift. 

(E) A weekly summary note shall be com- 
pleted in halfway houses, supervised inde- 
pendent living and alternative family 
living. 

(g) & Faculties Serving More Than One Disa- 
bility (except for sheltered workshops): 

(1) An individual client plan for services to 
be provided by the facility shall be devel- 
oped jointly by the client, facility staff and 
the qualified mental health professional, 
qualified developmental disabilities pro- 
fessional or the qualified substance abuse 
professional, as appropriate, who is re- 



sponsible for the client's treatment, pro- 
gram or case management plan within 30 
days of admission to the facility. This 
plan shall include at least the following: 

(A) Sp e cified specified goals and strategies 
to be carried out by the facility staff to 
support the attainment of goals specified 
by the qualified mental health profes- 
sional, qualified developmental disabilities 
professional or qualified substance abuse 
professional who has designated responsi- 
bility for the client's treatment, program 
or case management plan; and 

(B) Documentation documentation of joint 
development of the individual client plan 
by the client or legally responsible person, 
the facility staff and the professional who 
has designated responsibility for the cli- 
ent's treatment, program or case manage- 
ment plan. 

(2) Progress notes shall be completed on at 
least a monthly basis which reflect: 

(A) The client's progress or lack of progress 
in relation to his goals and strategies 
within the client plan; and 

(B) Documentation of coordination be- 
tween the facility and the professional 
who has designated responsibility for the 
client's treatment, program or case man- 
agement plan. 

(3) A thorough review of the individual client 
plan shall be carried out annually or more 
frequently if medically or clinically indi- 
cated. The review of the individual client 
plan shall be conducted cooperatively by 
the client or legally responsible person, the 
facility staff and the professional who has 
designated responsibility for the client's 
treatment, program or case management 
plan. 

Statutory Authority G.S. 122C-26; 143B-I47. 

CHAPTER 18 - MENTAL HEALTH: OTHER 
PROGRAMS 

SUBCHAPTER 18L - PROGRAM COMPONENT 
OPERATIONAL STANDARDS 

SECTION .1500 - EARLY INTERVENTION 
SERVICES PROCEDLRE SAFEGUARDS 

.1522 WRITTEN CONSENT REQLIRED 

Except as provided in Rule .1510 of this Sec- 
tion, all disclosures of confidential information, 
including disclosures between an area program 
and contract agency, may be made only with the 
written consent of the parents. Client informa- 
tion mav be disclosed between agencies partic- 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



57 



PROPOSED RULES 



ipating in the provision of early intervention 
services in accordance with G.S. 122C-53(a), 
122C-55(c), 122C-55(f), or 122C-55(h), as ap- 
propriate. However, the extent of information 
disclosed shall be limited to that information 
which is necessary to carry out the purpose of the 
disclosure. Parents shall be informed of their 
right to refuse to consent to the release of confi- 
dential information. 

Statutory Authority G.S. 143B-147; 150B-l(d); 
20 U.S.C. Sections 1401 et. seq., 1471 et.seq. 

****************** 



used for any suspension, expulsion or other dis- 
charge not mutually agreed upon and establish 
documentation requirements which shall include: 

(1) the specific time and conditions for re- 
suming services following a suspension; 

(2) designation of a» any alternative service 
determined to meet the client's needs; the 
facility shall exert its best effort to identify 
an alternative service; and 

(3) discharge plan. 

Statutory Authority G.S. 122C-51; 143B-147. 

SECTION .0200 - INFORMING CLIENTS AND 
STAFF OF RIGHTS 



lyotice is hereby given in accordance with G.S. 
1 SOB- 12 that the Commission for Mental Health, 
Developmental Disabilities and Substance Abuse 
Services intends to amend rule (s J cited as 10 
NCAC 14Q .0102; .0201 - .0202; .0305; 14R 
.0101; .0103 - .0107; .0201 and .0302. 

1 he proposed effective date of this action is A u- 
gust 28, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on May 15, 1991 at the Archdale Building, 
512 N. Salisbury St., Raleigh, XC 27604-1159, 
Public Hearing Room - Ground Floor. 

\_somment Procedures: Any interested person 
may present his comments by oral presentation or 
by submitting a written statement. Persons wish- 
ing to make oral presentations should contact 
Marilyn Brothers, Division of Mental Health. De- 
velopmental Disabilities and Substance Abuse 
Services, 325 N. Salisbury St.. Raleigh, NC 
27603. (919) 733-4774 by May 14, 1991. Written 
comments must be sent to the above address and 
must state the rule(s) to which the comments are 
addressed. Fiscal information on these rules is 
also available from the same address. 



SUBCHAPTER 14Q - GENERAL RIGHTS 

SECTION .0100 - GENERAL POLICIES AND 
PROCEDURES 

.0102 SUSPENSION AND EXPULSION POLICY 

(a) Clients shall be free from threat or fear of 
unwarranted suspension or expulsion from ser- 
vices. 

(b) The governing body shall develop and im- 
plement policies assuring 4«» proc e ss fair proce- 
dures for suspending or expelling clients from 
services. Policies shall address the criteria to be 



.0201 INFORMING CLIENTS OF RIGHTS 
AND RESTRICTIONS 

(a) A written summary of client rights as spec- 
ified in G.S. 122C, Article 3 shall be made avail- 
able to all clients and legally responsible persons. 

(b) Policies specified in Rule .0101(b) of this 
Subchapter shall assure that all clients and legally 
responsible persons are informed: 

(1) of the client's rights; potential restrictions 
ef H*e ef interventions; 

(2) of potential restrictions or use of planned 
interventions bv the facilities defined in 10 
NCAC 140 .0101(b); 

(3) (3) that the legally responsible person of a 

minor or incompetent adult client may 
request notification after any occurrence 
of the use of an intervention procedure as 
specified in Subchapter 14R, Section 
.0100 of these Rules; 

(4) (4) that the competent adult client may 
designate an individual to receive notifi- 
cation, in accordance with G.S. 
122C-53(a), after any occurrence of the 
use of an intervention procedure as speci- 
fied in Subchapter 14R, Section .0100 of 
these Rules; 

(5) (4} of notification provisions regarding 
emergency and intervention procedures, 
as delineated in Subchapter 14R, Section 
.0100 of these Rules; and 

(6) (4) of notification provisions regarding the 

restriction of client rights as specified in 
G.S. 122C-62(e). 

Statutory Authority G.S. 122C-51; 143B-147. 

.0202 INFORMING CLIENTS OF FACILITY 
POLICIES 

(a) Each client shall be informed of facility 
policies concerning client rights at the time of 
admission or entry into the service, or as soon 
as feasible, but no longer than 72 hours there- 
after. Documentation in the client record shall 



58 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



reflect that the client or legally responsible person 
has been informed of facility policies. 

(b) Procedures shall be implemented to assure 
that each client and legally responsible person 
shall be informed of the following: 

( 1 ) the procedure for obtaining a copy of the 
client's treatment or program plan and 
discharge plan; 

(2) any rules that the client is expected to 
follow and possible penalties for vio- 
lations; 

(3) the governing body grievance procedures 
including the individual to contact and 
procedures for assisting clients as needed; 

(4) the governing body policy regarding sus- 
pension and expulsion; 

(5) the governing body policy regarding fee 
assessment and collection practices for 
treatment or habilitation services; 

(6) the client's protections regarding disclosure 
of confidential information, as delineated 
in G.S. 122C-52 through G.S. 122C-56; 
and 

(7) the policy on search and seizure. 

Statutory Authority G.S. 122C-51 through 
122C-56; 122C-62; 143B-147. 

SECTION .0300 - GENERAL CIVIL, LEGAL AND 
HUMAN RIGHTS 

.0305 PROTECTION FROM HARM, ABUSE, 
NEGLECT OR EXPLOITATION 

(a) Each governing body shall develop policies 
in accordance with G.S. 122C-59, G.S. 122C-65, 
and G.S. 122C-66. 

(b) Employees shall protect clients from harm, 
abuse, neglect and exploitation in accordance 
with G.S. 122C-66. 

(c) Employees shall not subject a client to any 
sort of neglect or indignity, or inflict physical or 
mental abuse upon any client including, but not 
limited to, striking, burning, cutting, teasing, 
pinching, taunting, jerking, pushing, tripping or 
baiting a client. 

(d) Employees shall not sell or buy goods or 
services to or from a client except in professional 
services delivered by the client, in public retail or 
through established governing body policy. 

(e) Employees shall use only that degree of 
force necessary to repel or secure a violent and 
aggressive client and which is permitted by gov- 
erning body policy. The degree of force that is 
necessary depends upon the individual character- 
istics of the client (such as age, size and physical 
and mental health) and the degree of 
aggressiveness displayed by the client. Use of 



intervention techniques shall be in compliance 
with Subchapter 14R of this Chapter. 

(f) Each governing body must develop moni- 
toring procedures to assure compliance with G.S. 
122C-59, G.S. 122C-65, and G.S. 122C-66. 

Statutory Authority G.S. J22C-59; 122C-65; 
122C-66; 143B-147. 

SUBCHAPTER 14R - TREATMENT OR HABILI- 
TATION RIGHTS 

SECTION .0100 - PROTECTIONS REGARDING 
INTERVENTION PROCEDURES 

.0101 LEAST RESTRICTIVE ALTERNATIVE 

(a) 44%e geal »f aH treatment a*4 habilitation 
shall be Eacilities shall strive to provide services 
in the least restrictive, most appropriate and ef- 
fective positive treatment modalities. 

(b) Any intervention procedure designed to re- 
duce a behavior shall always be accompanied by 
positive treatment or habilitation methods. 

Statutory Authority G.S. 122C-51; 122C-53; 
131E-67; 143B-147. 

.0103 GENERAL POLICIES REGARDING 
INTERVENTION PROCEDURES 

(a) This Rule applies only to services facilities 
utilizing the following interventions: 

(1) exclusionary time-out for more than 15 
minutes; 

(2) time-out for more than one hour; 

(3) contingent withdrawal or delay of access 
to personal possessions or goods to which 
the client would ordinarily be entitled; 

(4) consistent deprivation of items or cessa- 
tion of an activity which the client is 
scheduled to receive (other than basic ne- 
cessities); 

overcorrection to which the client resists; 
and 

other interventions specified in Rule .0104 
and Rule .0106 of this Section. 

The governing body shall develop policies 
and procedures for the use of interventions spec- 
ified in Paragraph (a) of this Rule, determined to 
be acceptable for use in the facility. Such policies 
shall include: These policies and procedures shall 
be in accordance with the provisions of Subpar- 
agraph ( 1) or (2) of this Paragraph. 

( 1) Such policies and procedures, approved 
bv the Commission, shall ensure: 

(A) timely notice and explanations to the 
client, legally responsible persons and, if 
requested, by the clients or others; 

(B) valid opportunities to consent to or re- 
fuse planned interventions; 



(5) 
(6) 
(b) 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



59 



PROPOSED RULES 



(C) the intervention is justified, properly 
time-limited, not applied too frequently, 
and that appropriate positive and less in- 
trusive alternatives are thoroughly, sys- 
tematically and continuously considered 
and used; 

(D) as soon as the intervention is used on 
a recurring or planned basis, the inter- 
vention will be incorporated into a treat- 
ment or habitation plan which contains 
sufficient specifics to ensure adequate 
follow-through and accountability; 

(F) implementation by trained staff, closely 
supervised by credentialed professional; 

(F) manner, conditions and location of the 
intervention are safe and humane; 



(G) implementation is adequately moni- 
tored and the monitoring results are 
properly disseminated to assure adequate 
follow-through, continuing justification 
and timely adjustment to meet changing 
circumstances: and 

(H) that the safeguards in this Rule are ad- 
equately documented. 
(2) Such policies and procedures shall include: 

(A) (44 procedures for ensuring that the 
competent adult client or legally responsi- 
ble person of a minor client or incompe- 
tent adult client is informed: 

(i) (-A-} of the general types of inter- 
ventions that are authorized for use by 
the facility; and 

dil (-&} that the legally responsible person 
can request notification of each use of 
an intervention as specified in this Rule, 
in addition to those situations required 
by G.S. 122C-62. When multiple 
interventions are required during a 
24-hour period, such notification may 
be summarized to the legally responsi- 
ble person one time during each 
24-hour period; 

(iii) (44 that the competent adult client 
may designate an individual to receive 
notification, in accordance with G.S. 
122C- 53(a), after any occurrence of the 
use of an intervention procedure as 
specified in Subchapter 14R, Section 
.0100 of this Chapter. 

(B) (-3} provisions for humane, secure and 
safe conditions in areas used for the inter- 
vention, such as adequate ventilation, 
light and a room temperature consistent 
with the rest of the facility; 

(C) (4+ appropriate attention paid to the 
need for fluid intake and the provision of 
regular meals, bathing and the use of the 



toilet. Such attention shall be docu- 
mented in the client record; and 
(D) (4) procedures for assuring that when 
an intervention as specified in this Rule 
has been used with a client three or more 
times in a calendar month, the following 
requirements are met: 
(i) (A) A treatment or program plan de- 
veloped within ten working days of the 
third intervention. The treatment or 
program plan shall include, but not be 
limited to: 

(I) (4 indication of need; 

(II) (*4 specific description of problem 
behavior; 

(III) (») specific goal to be achieved 
and estimated duration of procedure; 

(IV) («4 specific early intervention 
when precursor behaviors are exhib- 
ited; 

(V) (v) specific procedure to be em- 
ployed; 

(VI) {*ri} specific methodology of the 
intervention; 

(VII) f44 methods for measuring 
treatment efficacy; 

(VIII) (viii) guidelines for discontinua- 
tion of the procedure; 

(IX) 4*4 the accompanying positive 
treatment or habilitation methods 
which are intended to be as strong as 
the negative aspects of the plan; and 

(X) (*) the specific limitations on ap- 
proved uses of the intervention per 
episode and per day and requirements 
for on-site assessments by the re- 
sponsible professional. 

(ii) 434 In emergency situations, a quali- 
fied professional may continue to use 
the intervention until the planned 
intervention is addressed in the treat- 
ment or program plan. 

(in) (-G4 The qualified professional shall 
explain the intervention and the reason 
for the intervention to the client and the 
legally responsible person, if applicable, 
and document such explanation in the 
client record. 

(iv) (444 Before implementation of the 
planned intervention, the treatment or 
habilitation team, if there is one, shall 
approve the treatment or program plan. 

(v) 44 The use of the intervention shall 
be reviewed at least monthly by the 
treatment or habilitation team. 

(vi) 44) If a client or legally responsible 
person refuses the use of such proce- 
dures, the right to refuse treatment 



611 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



procedures as required in Rule .0302 of 
this Subchapter shall be followed. 
(vii) £G) The interventions specified in 
this Rule shall never be the sole treat- 
ment modality designed to eliminate the 
target behavior. Interventions are to 
be used consistently and shall always 
be accompanied by positive treatment 
or habilitation methods. 
(c) If the governing body chooses to comply 
with Subparagraph (b)(2) of this Rule, the fol- 
lowing provisions shall also be applicable: 

( 1) (e) Whenever the interventions as specified 

in this Subchapter result in the restriction 
of a right in a 24-hour facility as specified 
in G.S. 122C-62(b) and (d), procedures 
specified in G.S. 122C-62(e) shall be fol- 
lowed. Exceptions to this Rule include 
the use of seclusion, restraint and isolation 
time-out, which are regulated in Rule 
.0104 of this Section. 

(2) (4) Facility employees who authorize and 

implement interventions shall be privi- 
leged to do so, as well as to utilize alter- 
native approaches. Such assurances shall 
be documented and maintained in the 
personnel records of facility employees. 

(3) (&f Statistical records that reflect the fre- 

quency and duration of the individual uses 
of interventions specified in this Rule shall 
be maintained. This statistical record 
shall be made available to the Human 
Rights Committee, if there is one, and the 
governing body at least quarterly. 

Statutory Authority G.S. 122C-SI; 122C-53; 
I22C-60; 122C-62; 13/E-67; I43B-I47. 

.0104 SECLUSION, RESTRAINT 

AND ISOLATION TIME OUT 

(a) This Rule delineates the procedures to be 
followed for seclusion, restraint and isolation 
time-out in addition to the procedures specified 
in Rule .0103(b) through (e* (c) of this Section. 

(b) Those facilities which intend to employ the 
use of mechanical restraint or seclusion of a client 
shall be designated as a restrictive facility by the 
Division of Facility Services. 

(c) This Rule governs the use of specific phys- 
ical or behavioral interventions which are used to 
terminate a behavior or action in which a client 
is in imminent danger of abuse or injury to self 
or other persons or when substantial property 
damage is occurring, or which is used as a meas- 
ure of therapeutic treatment. Such interventions 
include: 

(1) seclusion; 

(2) restraint; and 



(3) isolation time-out. 
(d) The use of seclusion, restraint and isolation 
time-out shall be limited to those situations 
specified in G.S. 122C-60, which include: 

(1) emergency interventions (planned and 
unplanned); and 

(2) therapeutic treatment as specified in Rule 
.0106 of this Section. 

v- i tt i_i\_ lvi 1 1 in n_"u rrr tt^ uvw uiuuiu l \J i u_^J t i 1111111 

the facility, the The governing body shall e ctab 
feh develop written policies and procedures that 
govern the use of seclusion, restraint and iso- 
lation time-out, which ohall includ e the follow 
»gf if determined to be acceptable for use within 
the facility. These policies and procedures shall 
be in accordance with the provisions of Subpar- 
agraph Q) or (2) of this Paragraph. 

( 1) Such policies and procedures, approved 
by the Commission, shall ensure: 

(A) timely notice and explanations to the 
client, legally responsible persons and if 
requested by the clients or others; 

(B) valid opportunities to consent to or re- 
fuse planned interventions; 

(C) the intervention is justified, properly 
time-limited, not applied too frequently, 
and that appropriate positive and less in- 
trusive alternatives are thoroughly, sys- 
tematically and continuously considered 
and used; 

(D) as soon as the intervention is used on 
a recurring or planned basis, the inter- 
vention will be incorporated into a treat- 
ment or habilitation plan which contains 
sufficient specifics to ensure adequate 
follow-through and accountability; 

(F) implementation by trained stall", closely 
supervised by credentialed professional; 

(F) manner, conditions and location of the 
intervention are safe and humane; 



(G) implementation is adequately moni- 
tored and the monitoring results are 
properly disseminated to assure adequate 
follow-through, continuing justification 
and timely adjustment to meet changing 
circumstances; and 

(H) that the safeguards in this Rule are ad- 
equately documented. 
(2) Such policies shall include: 

(A) (44 process for identifying and privileg- 
ing facility employees who may authorize 
and implement such interventions; 

(B) (4) provisions that a qualified or re- 
sponsible professional shall: 

(i) (A4 review the use of the intervention 
as soon as possible but at least within 
one hour of the initiation of its use; 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



61 



PROPOSED RULES 



(ii) (-8} verify the inadequacy of less re- 
strictive intervention techniques; and 

(iii) fG+ document in the client record ev- 
idence of approval or disapproval of 
continued use. 

(C) (4+ procedures for documenting in the 
client record the intervention which oc- 
curred, to include, but not be limited to: 
(i| (A) the rationale for the use of the 

intervention which also addresses the 
inadequacy of less restrictive inter- 
vention techniques; 

(iil (-B} notation of the frequency, inten- 
sity and duration of the behavior and 
any precipitating circumstance contrib- 
uting to the onset of the behavior: 

(iii) (&) description of the intervention 
and the date, time and duration of its 
use; and 

(iv) (©} signature and title of the facility 
employee responsible for the use of the 
intervention. 

(D) f-H procedures for the notification of 
others to include: 

(i) (-At} those to be notified as soon as 
possible but no more than 72 hours af- 
ter the behavior has been controlled to 
include: 

(I) (+) the treatment or habilitation 
team, or its designee, after each use 
of the intervention; and 

(II) (4*) a designee of the governing 
body. 

(ii) (-&} notification in a timely fashion of 
the legally responsible person of a mi- 
nor client or an incompetent adult cli- 
ent when such notification has been 
requested. 
(F) (S} procedures to identify clients with 
reasonably foreseeable physical conse- 
quences to the use of restraint, shall in- 
clude, but not be limited to: 
(i) (A) documentation of clients with 
physical disability or past surgical pro- 
cedures that would make affected nerves 
and bones sensitive to injury; and 
I ii ) (-&} the identification and documenta- 
tion of alternative emergency proce- 
dures if needed. 
(f) If the governing body does not choose to 
comply with Subparagraph (e)(2) of this Rule, 
the following provisions shall be applicable: 
( 1 ) H-> Any room used for seclusion or isolation 
time-out shall meet the following criteria: 
(A) f-H The room shall be designed and 
constructed to ensure the health, safety 
and well-being of the client. 



(B) Q The floor space shall not be less than 
50 square feet, with a ceiling height of not 
less than eight feet. 

(C) f4> Floor and wall coverings, as well as 
any contents of the room, shall have a 
one-hour fire rating and shall not produce 
toxic fumes if bumed. 

(D) (-4+ The walls shall be kept completely 
free of objects. 

(E) f^f A lighting fixture, equipped with a 
minimum of a 75 watt bulb, shall be 
mounted in the ceiling and be screened to 
prevent tampering by the client. 

(F) (44 One door of the room shall be 
equipped with a window mounted in a 
manner which allows inspection of the 
entire room. Glass in any windows shall 
be impact resistant and shatterproof. 

(G) f-3^- The room temperature and venti- 
lation shall be comparable and compatible 
with the rest of the facility. 

(H) (-84 In a room where the door is not 
under direct observation by staff and if a 
staff person is not assigned to contin- 
uously observe the area during the dura- 
tion of the confinement, the lock on the 
room shall be interlocked with the fire 
alarm system so that the door automat- 
ically unlocks when the fire alarm is acti- 
vated. 

(2) fg4 Seclusion, restraint and isolation time- 

out shall not be employed as retaliation 
or for the convenience of staff or used in 
a manner that causes harm or undue 
physical or mental discomfort or pain to 
the client. 

(3) fh4 Whenever seclusion, restraint or iso- 

lation time-out is used on an emergency 
basis prior to inclusion in the treatment 
or program plan, the following procedures 
shall be followed: 

(A) (4+ A facility employee privileged to ad- 
minister emergency interventions may 
employ such procedures for up to 15 
minutes without further authorization. 

( B) f4+ A qualified professional who has ex- 
perience and training in the use of seclu- 
sion, restraint or isolation time-out and 
who has been privileged to employee such 
interventions, may authorize the contin- 
ued use of such interventions for up to 
one hour from the time of initial employ- 
ment of the intervention. If a qualified 
professional is not immediately available 
to conduct an assessment of the client, but 
after discussion with the facility employee, 
concurs that the intervention is justified 
for longer than 15 minutes, continuation 



6:2 l\ORTH CAROLISA REGISTER April 15, 1991 



PROPOSED RULES 



of the intervention may be verbally au- 
thorized for up to one hour. The quali- 
fied professional shall observe and assess 
the client within one hour after authoriz- 
ing the continued use of the intervention. 
If the intervention needs to be continued 
for longer than one hour, the professional 
responsible for the client's treatment or 
program plan shall be consulted. 

(C) (4) Use of isolation time-out shall not 
exceed one hour in Intermediate Care 
Facilities for the Mentally Retarded 
(ICF/MR). 

(D) (4) The continued use of seclusion or 
restraint for over one hour shall only be 
authorized by the responsible profes- 
sional. If the responsible professional is 
not immediately available to conduct a 
clinical assessment of the client, but after 
discussion with the qualified professional, 
concurs that the seclusion or restraint is 
justified for longer than one hour, contin- 
uation of the intervention may be verbally 
authorized until an on-site assessment of 
the client can be made. The responsible 
professional shall meet with and conduct 
an assessment of the client and write such 
authorization within 12 hours from the 
time of initial employment of the inter- 
vention. 

(4) (i) Whenever a client is in seclusion, re- 

straint or isolation time-out for more than 
24 continuous hours, the client's rights, 
as specified in G.S. 122C-62(b) and (d), 
are restricted. The documentation re- 
quirements in this Rule shall satisfy the 
requirements specified in G.S. 122C-62(e) 
for restriction of rights in G.S. 122C-62(b) 
and (d). Rights specified in G.S. 

122C-62(a) and (b) shall be exercised at 
reasonable intervals. 

(5) (44 Whenever seclusion, restraint, or iso- 

lation time-out is used more than three 
times in 30 consecutive days, the proce- 
dure shall be addressed as a planned 
intervention in the treatment or program 
plan. 

(6) (4*4 In addition to the requirements in this 

Rule, additional safeguards as specified in 
Rule .0106 of this Section shall be initi- 
ated under the following conditions: 

(A) (4-^ whenever a client exceeds spending 
40 hours, or more than one episode of 24 
or more continuous hours in emergency 
seclusion, restraint or isolation time-out 
during 30 consecutive days; or 

(B) (-S^ whenever seclusion, restraint or iso- 
lation time-out is used as a measure of 



therapeutic treatment as specified in G.S. 
122C-60 and is limited to specific planned 
behavioral interventions designed for the 
extinction of dangerous, aggressive or un- 
desirable behaviors. 

(7) (44 The written approval of the designee of 

the governing body shall be required when 
seclusion, restraint or isolation time-out 
is utilized for longer than 24 continuous 
hours. 

(8) (#$4 Standing orders or PRN orders shall 

not be used to authorize the use of seclu- 
sion restraint or isolation time-out. 

(9) (»> The client shall be removed from se- 

clusion, restraint or isolation time-out as 
soon as therapeutically appropriate but in 
no case shall the client remain in seclu- 
sion, restraint or isolation time-out longer 
than 30 minutes after gaining behavioral 
control. If the client is unable to gain 
self-control within the time frame speci- 
fied in the authorization, a new authori- 
zation must be obtained. 

(10) (») While the client is in seclusion, re- 
straint or isolation time-out, the following 
precautions shall be followed: 

(A) (44 Whenever a client is in seclusion or 
restraint, periodic observation of the client 
shall occur at least every 15 minutes, or 
more often as necessary, to assure the 
safety of the client. Appropriate attention 
shall be paid to the provision of regular 
meals, bathing, and the use of the toilet. 
Such observation and attention shall be 
documented in the client record. 

(B) (44 Whenever a client is in isolation 
time-out, there shall be a facility employee 
in attendance with no other immediate 
responsibility than to monitor the client 
who is placed in isolation time-out. 
There shall be continuous observation 
and verbal interaction with the client 
when appropriate. Such observation shall 
be documented in the client record. 

(C) (4) When restraint is used in the absence 
of seclusion and the client may be subject 
to injury, a facility employee shall remain 
present with the client continuously. 

(11) (p4 Reviews and reports on the use of se- 
clusion, restraint and isolation time-out 
shall be conducted as follows: 

(A) (4) all uses of seclusion, restraint and 
isolation time-out shall be reviewed in a 
timely fashion by a designee of the gov- 
erning body and unusual or possibly un- 
warranted patterns of utilization shall be 
investigated; 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



63 



PROPOSED RULES 



( B) f3> a log which includes the following 
information on each use of restraint, se- 
clusion and isolation time-out shall be 
maintained: 

(i) fA} name of the client; 
(li) f&) name of the responsible profes- 
sional; 
(iii) f€} date of each intervention; 
(iv) f©} time of each intervention; 
(v) ffe) type of intervention; 
(vi) f4^ duration of each intervention; and 
(vii) (4+) reason for use of the inter- 
vention. 
(12) fq4 Nothing in this Rule shall be inter- 
preted to prohibit the use of voluntary' 
seclusion, restraint or isolation time-out 
at the client's request; however, the pro- 
cedures in this Rule shall apply with the 
exception of Subparagraphs (e)(3)(A) 
(e)(2)(B)(i) and (-B} (11^ and Paragraph fh> 
Subparagraph (f)(3) of this Rule. 

Statutory Authority G.S. 122C-51; 122C-53; 
I22C-60; I22C-62; 131E-67; I43B-147. 

.0105 PROTECTIVE DEVICES 

(a) Whenever protective devices are utilized for 
clients, the governing body shall develop policies 
to ensure that: 

( 1 ) the necessity for the protective device has 
been assessed and the device applied by a 
profc - ooionul person who has been trained 
and privileged in the utilization of protec- 
tive devices; 

(2) the protective device is the least restrictive 
appropriate measure; 

(3) the client is frequently observed and pro- 
vided opportunities for toileting, exercise, 
etc. as needed. Protective devices which 
limit the client's freedom of movement 
shall be observed at least even' hour. 
Whenever the client is restrained and 
subject to injury by another client, a fa- 
cility employee shall remain present with 
the client continuously. Observations and 
interventions shall be documented in the 
client record; 

(4) protective devices are cleaned at regular 
intervals; and 

(5) the utilization of protective devices in the 
treatment or program plan shall be subject 
to review by the Human Rights Commit- 
tee, if there is one. 

(b) In addition to the requirements specified in 
Paragraph (a) of this Rule, protective devices 
used for behavioral control which have the effect 
of significantly restraining the client's freedom of 
movement shall comply with the requirements 



specified in Rule .0103 and Rule .0104 of this 
Section. 

Statutory Authority G.S. I22C-51; I22C-53; 
122C-60; 131E-67; I43B-I47. 

.0106 INTERVENTIONS REQUIRING 
ADDITIONAL SAFEGUARDS 

(a) This Rule applies only to services utilizing 
interventions specified in Paragraph (b) of this 
Rule which present a significant risk to the client 
and, therefore, require additional safeguards. 
These procedures shall be followed in addition to 
the procedures specified in Rule .0103 and Rule 
.0104 of this Section if seclusion, restraint or iso- 
lation time-out is utilized. 

(b) The following interventions are designed for 
the primary purpose of reducing the incidence of 
aggressive, dangerous or self injurious behavior 
to a level which will allow the use of less intrusive 
treatment or habilitation procedures. Such 
interventions include the use of: 

(1) seclusion, restraint or isolation time-out 
employed as a measure of therapeutic 
treatment; and 

(2) seclusion, restraint, isolation time-out used 
on an emergency basis more than 40 
hours in a calendar month or more than 
one episode of 24 hours. 

(c) The governing body shall develop policies 
and procedures regarding additional safeguards if 
seclusion, restraint or isolation time-out are de- 
termined to be acceptable for use in the facility. 
Ihese policies and procedures shall be in ac- 
cordance with the provisions of Subparagraph ( 1 ) 
or [2] of this Paragraph: 

( 1 ) such policies and procedures, which shall 
be approved by the Commission, shall 
ensure: 

(A) timely notice and explanations to the 
client, legally responsible persons and if 
requested by the clients or others; 

(B) valid opportunities to consent to or re- 
fuse planned interventions; 

(C) the intervention is justified, properly 
time-limited, not applied too frequently, 
and that appropriate positive and less in- 
trusive alternatives are thoroughly, sys- 
tematically and continuously considered 
and used; 

(D) as soon as the intervention is used on 
a recurring or planned basis, the inter- 
vention will be incorporated into a treat- 
ment or habilitation plan which contains 
sufficient specifics to ensure adequate 
follow-through and accountability; 

(E) implementation by trained staff, closely 
supervised by credentialed professional; 



64 



6:2 NORTH CAROLINA REGISTER April 15, 1 99 1 



PROPOSED RULES 



(F) manner, conditions and location of the 
intervention are safe and humane; 



(G) implementation is adequately moni- 
tored and the monitoring results are 
properly disseminated to assure adequate 
follow-through, continuing justification 
and timely adjustment to meet changing 
circumstances; and 
(H) that the safeguards in this Rule are ad- 
equately documented. 
(2) If the governing body chooses not to de- 
velop policies and procedures as stated in 
Subparagraph (c)( 1) the following pro- 
visions shall apply: 

(A) fe} Such interventions shall never be the 
sole treatment modality for the elimi- 
nation of target behavior. The inter- 
vention shall always be accompanied by 
positive treatment or habitation methods 
which include the deliberate teaching and 
reinforcement of behaviors which are 
non-injurious; the improvement of condi- 
tions associated with non-injurious be- 
haviors such as an enriched educational 
and social environment; and the alteration 
or elimination of environmental condi- 
tions which are reliably correlated with 
self-injury. 

(B) (-4+ Prior to the implementation of any 
planned use of the interventions specified 
in Paragraph (b) of this Rule, the follow- 
ing written approvals and notifications 
shall be obtained and documented in the 
client record; 

(ij f44 The responsible professional and 
the treatment or habilitation team if 
there is one shall approve the plan. 

(ii) f4> Each client whose treatment or 
program plan includes interventions 
with reasonably foreseeable physical 
consequences shall receive an initial 
medical examination and periodic 
planned monitoring by a physician. 

(iii) {3j The governing body shall assure 
that a client advocate has been identi- 
fied and informed that the intervention 
has been planned for the client and the 
rationale for utilization of the inter- 
vention. 

(iv) {4} The governing body shall assure 
that an Intervention Advisory Com- 
mittee as defined in Rule .0107 of this 
Section has been organized and in- 
formed regarding the intervention being 
planned for the client. Confidential in- 
formation provided to the advisory 
committee shall be within the con- 
straints of G.S. 122C-53(a). 



(v) (4} A designee of the treatment or ha- 
bilitation team shall explain the inter- 
vention and the reason for the 
intervention to the client and the legally 
responsible person, if applicable. The 
prior written consent of the client or 
legally responsible person shall be ob- 
tained except for those situations speci- 
fied in Rule .0104 (4r#4-> (f)(6)(A) of 
this Section. If the client or legally re- 
sponsible person, if applicable, refuses 
the intervention, the governing body's 
procedures regarding the right to refuse 
treatment procedures shall be followed. 

(C) f^ If any of the persons or committees 
specified in Subparagraphs (d)(1), (-^ H-h 
e* & (c)(2)(B)(i), (u), (iii), (iv) or (v) of 
this Rule do not approve the continued 
use of a planned intervention, the planned 
intervention shall be terminated. The 
governing body shall establish an appeal 
mechanism for the resolution of any disa- 
greement over the use of the intervention. 

(D) (f} Neither the consents nor the ap- 
provals specified in Paragraph (4) Sub- 
paragraph (c)(2)(B) of this Rule shall be 
considered valid for more than six 
months. The responsible professional and 
the treatment or habilitation team, if there 
is one, shall re-evaluate the use of the 
intervention and obtain the client's and 
legally responsible person's consent for 
continued use of the intervention. The 
decision to continue the intervention shall 
be based on clear and recent behavioral 
evidence that the intervention is having a 
positive impact and continues to be 
needed. 

(E) (§) The plan shall be reviewed at the 
next meeting of the Intervention Advisory 
Committee within the constraints of 10 
NCAC 18D .0215, division publication 
APSM 45-1. 1/10/86, 
(CONFIDENTIALITY RULES), 
adopted pursuant to G.S. 150B- 14(c). 
The Committee, by majority vote, may 
recommend approval or disapproval of 
the plan or may abstain from making a 
recommendation. Implementation of the 
intervention shall be reviewed by the 
Committee within 30 days of the initiation 
of the plan. 

(F) {&■} The intervention shall be used only 
when the responsible professional and the 
treatment or habilitation team, if there is 
one, has determined and documented in 
the client record the following; 



6:2 NORTH CAROLINA REGISTER April 15, 1 99 1 



65 



PROPOSED RULES 



(i) (44 that the client is engaging in be- 
haviors that are dangerous, aggressive 
and likely to result in injury to self or 
others; 
(ii) (44 that other methods of treatment 
or habilitation employing less intrusive 
interventions are not appropriate or ef- 
fective, with the reasons supporting this 
determination; 
(iii) (44 the frequency, intensity and dura- 
tion of the target behavior, and the be- 
havior's probable antecedents and 
consequences; and 
(iv) f-+4 that in the case of aversive inter- 
ventions, a systematic study on alterna- 
tives to such interventions has been 
conducted and other non-aversive tech- 
niques have been tried and did not 
work. 
(G) (+4 Accurate and up-to-date written re- 
cords shall be maintained on the applica- 
tion of the intervention and 
accompanying positive procedures. These 
records shall include at a minimum the 
following: 

(ri (44 data which reflect the frequency, 
intensity and duration with which the 
targeted behavior occurs (scientific 
sampling procedures are acceptable I; 
(ii) (44 data which reflect the frequency, 
intensity and duration of the inter- 
vention and any accompanying positive 
procedures; and 
(in) (44 data which reflect the facility em- 
ployees who administered the inter- 
ventions. 
(H) f}4 The governing body shall assure that 
the interventions are evaluated at least 
weekly and are documented in the client 
record. A qualified professional shall be 
involved in this evaluation at least every 
other week. 
(I) (4*4 During the use of the intervention, 
the intervention advisory committee shall 
be given the opportunity to review the 
treatment or program plan within the 
constraints of 10 NCAC 18D .0215 divi- 
sion publication APSM 45-1, 1.10.86, 
(CONFIDENTIALITY RULES) 

adopted pursuant to G.S. 150B- 14(c). 

Statutory Authority G.S. 122C-51; 122C-53: 
122C-57; 122C-60; 122C-62; 131E-67; 143B-14' 7 . 

.0107 INTERVENTION ADVISORY 
COMMITTEES 

(a) Intervention advisory committees shall be 
established to provide an additional safeguard in 



those facilities that utilize intrusive treatment or 
habilitation interventions specified in Rule 14R 
.0106. For facilities operated by or under con- 
tract with an area program, the Intervention Ad- 
visory Committee shall be appointed by the 
Client Rights Committee. For facilities oper- 
ated by or under contract with an area program 
the Intervention Advisory Committee shall be 
the Client Rights Committee or a subcommittee 
of it which may include other members. 

(b) The Committee shall be composed »f in- 
clude at least three te five concerned citizens who 
are not employees of, or members of, the gov- 
erning body, ©fte ef the individualo shaH be The 
Intervention Advisory Committee shall have a 
member or a regular independent eon-nlt-tnt v. ho 
is a professional with training and expertise in the 
use of the type of interventions being utilized, 
who is not involved in the treatment or habili- 
tation of the client. The Committee shall also 
include at least one person who is or has been a 
consumer or who is a close relative of a con- 
sumer. 

(c) Each committee shall have policies govern- 
ing its operation. 

(d) The governing body shall assure that the 
committee is supplied with appropriate statutes 
and rules governing client rights and related is- 
sues and literature about the proposed inter- 
ventions and their alternatives. The governing 
body shall also assure that each member of the 
Committee has received specific training and ori- 
entation as to the charge of the Committee. 

(e) The Committee shall maintain minutes of 
each meeting. Care shall be taken that the min- 
utes do not violate the provisions of G.S. 
122C-52. 

(f) Each committee shall make an annual writ- 
ten report to the governing body on the activities 
of the Committee. 

(g) Committee members shall have access to 
client records on a need to know basis only upon 
the written informed consent of the client or his 
legally responsible person as specified in G.S. 
122C- 53(a). This access shall be given only 
when necessary for committee members to per- 
form their duties. 

(h) Committee members shall treat the client 
record as confidential information in accordance 
with G.S. 122C-52 through G.S. 122C-56. 

(i) Each committee shall have a caseload of not 
more than 30 clients whose intrusive inter- 
ventions are being reviewed. 

(-J4 A I Iuman Righto Committc - o serving 44* 
function s4»M comply Vrrth- tte R.ul e . 

Statutory Authority G.S. 122C-5I through 
122C-56; 143B-147. 



66 



6:2 NORTH CAROLINA REGISTER April 15, 1 991 



PROPOSED RULES 



SECTION .0200 - PROTECTIONS REGARDING 
MEDICATIONS 

.0201 SAFEGUARDS REGARDING 
MEDICATIONS 

(a) The facility shall follow the Rules in 10 
NCAC 14K .0349 through .0355, G.S. 122C-57, 
and G.S. 90, Articles 1, 4A and 9A when utilizing 
drugs or medication. 

(bj The use of experimental drugs or 
medication shall be considered research and shall 
be governed by 10 NCAC 14K .0333, a*4 .0334, 
aft4 G.S. 122C-57(f) and applicable federal law. 

(c) The governing body of a medical service 
which utilizes neuroleptic medications shall es- 
tablish the following policies and procedures rel- 
ative to utilization of such medications and 
safeguards for prevention of tardive dyskinesia in 
accordance with sound medical practice: 

( 1 ) methods fo? minimizing the risk of tardive 

dyskinesia by prescribing neuroleptic 
medication judiciously and in the lowest 
possible therapeutic dosages. 

(2) training aimed at education of facility staff 
regarding indications for using neuroleptic 
medication, expected therapeutic effects 
of neuroleptic medication and common 
side effects including indications of tardive 
dyskinesia; and 

(3) procedures fef monitoring clients on 
neuroleptic medications for signs of 
tardive dyskinesia including the following: 

(A) designation of a standardized procedure 
or rating system; 

(B) frequency of client examinations; 

(C) training and privileging of examiners in 
the selected methodology; and 

(D) documentation in the client record. 



Statutory Authority G.S. I22C-5I; 122C-57; 
131E-67; I43B-147. 



****************** 



Statutory Authority 
131E-67; 143B-147. 



G.S. 122C-51; 122C-57; 



SECTION .0300 - RIGHT TO REFUSE 
TREATMENT 

.0302 INTRUSIVE INTERVENTIONS 

(a) Interventions as specified in Rules .0103 
through .0106 of this Subchapter shall not be 
administered to a voluntary client in a non- 
emergency situation if the client or legally re- 
sponsible person refuses the interventions except 
for those situations specified in Rule 14R .0104 

$m* (0(6)(A). 

(b) The governing body shall develop and im- 
plement policies assuring due process procedures 
for involuntary clients who refuse the use of in- 
trusive interventions. 



No 



otice is hereby given in accordance with G.S. 
I SOB- 1 2 that the Director, Division of Mental 
Health, Developmental Disabilities and Substance 
Abuse Services intends to amend rules cited as 10 
NCAC 18 A .0124 - .0128, .0130, .0132 - .0133, 
.0135; and repeal rules cited as 10 NCAC 18 A 
.0129, .0131, .0134. 

1 he proposed effective date of this action is Au- 
gust 1, 1991. 

1 he public hearing will be conducted at 9:00 
a.m. on May 17, 1991 at the Albemarle Building, 
325 N. Salisbury Street, Room 864, Raleigh, NC 
27603. 

K^omment Procedures: Any interested person 
may present his comments by oral presentation or 
by submitting a written statement. Persons wish- 
ing to make oral presentations should contact 
Marilyn Brothers, Division of Mental Health, De- 
velopmental Disabilities and Substance Abuse 
Services, 325 North Salisbury Street, Raleigh, NC 
27603, (919) 733-4774 by May 16, 1991. Written 
comments must be sent to the above address and 
must state the rule(s) to which the comments are 
address. Fiscal information on these rules is also 
available from the same address. 

CHAPTER 18 - MENTAL HEALTH: OTHER 
PROGRAMS 

SUBCHAPTER 18A - MONITORING 
PROCEDURES 

SECTION .0100 - REVIEW PROCESS FOR AREA 

PROGRAMS AND THEIR CONTRACT 

AGENCIES 

.0124 SCOPE 

Rules S±2Z .0125 through .0136 in this Section 
apply to all area programs and their contract 
agencies. 

Statutory Authority G.S. 122C-113; 

122C-141(b); 122C-142(a); 122C-191(d). 

.0125 DEFINITIONS 

As used in this Section, the following terms 
have the meanings specified: 

(1) "APSM 10 1" moans frh# Division publico 
tfo» entitled "Roviow Process fof Ar e a Rfe- 
grams af*4 Their Contract Agencies" as 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



6' 



PROPOSED RULES 



effective? September h 1986. : f«e manual 
fftay ©e reviewed at atea program offices, 
regional offices, ©f fcbe Publications Office 
ef tee Division. Copies Fftay be obtained 
trom A* Publications Office ef tee Division 
at- a charge which covers printing aft4 post 
ae©r "Area program" means the legally 
constituted agency providing mental health. 
developmental disabilities, and substance 
abuse services, either directly or under con- 
tract. for a designated catchment area. 



loss of certification status for a service when 
the Division determines that an area pro- 



(2) "Biennial Review" means a self survey by 
a» aFea program a»4 att ©f its ar e a operated 
a»4 contract components which occurs a* 
least every tw© years i» accordance with tke 
rules » th*s Section aft4 instructions out 
lined » APSM ID 1 to d e termine continued 
compliance with applicable rules ©£ tee 
Commission a»4 tee Secretary. "Certif- 
ication" means the designation given a ser- 
vice bv the Division to mdicate: 



(a) compliance with all applicable statutes and 
rules of the Commission and the Secre- 
tary or 
lb) evidence that action is being taken to 
correct all out-of-comphance findings. 
(3) "Certification" m e ans tee designation given 
a component by tee Division t© indicat e t&e 
status ©f compliance with rules ©£ the Com 
mission aft©, the Secretary. Certification 
shall melude «» ef the following: 
frH- "Temporary Certification" means tee sta- 
te* given when a component »s temporar 
ily authorised t© receiv e state aftd- f e deral 
fund ', until aft. on site certification revi e w 
©f ftew- ©f currently uncertified compo 
nents ea» ©e conducted te determin e 
compliance status. 
<-©+ "Provisional Certification" means tee sta- 
tes given when a component is unable te 
comply with ©fte ©f more applicabl e rules 
aft©, tee non compliance does a»t present 
aft immediate throat t© health, welfare ©F 
safety ©t tee individuals served. 
te+ "Full Certification" means tee status given 
when a component fully complies with all 
applicable rules. 
"Commission" has the same meaning as 



(4) 



specified in G.S. 122C-C. 

Component" means a service developed te 



gram or its contract agency fails to meet ap- 
plicable statutes or rules v\ ithin designated 
time frames or when non-compliance pre- 
sents an immediate threat to health, welfare 
or safety cM the individuals served. Pcccr- 
titication mav result in the delay, reduction 
or denial of state and federal funds I nder 
the provisions of Pioneer and the State 
Medicaid Plan, payments will not he made 
for services which are decertified. 

(5) "Decertification" means the !©•*> ©1 cert if 
ication status following a review process f» 
which it is determined teat tee component 
is ft©t- licensed i» accordance with North 
Carohna statutes ©f certified m accordance 
with the rules » teis S e ction aft©. APSM 
■ 10 1. Decertification fftay- r e sult » tee ©e- 
lay-r reduction ©f denial ©f state aft4 federal 
funds, revocation ©f liconso. ©f 1©ss ©f 
Medicaid provider status. "Division" has 
the same meaning as specified in G.S. 122-C. 

(6) inventor , ©f Services" means a composite 
hst ©1 services provided ©y- a» area program 
©f area operated a»4 contract components 
as maintained ©y tee Chent Information 
Systems Branch ©f tee Division. 3tee m- 
ventory includes, ©te *s ft©t limited to? name, 
address. type ©f service, disability aft4 aee 
group serv e d. a»4 contract ©f area operated 
status. "Provider" means the person or 
agency responsible for the provision of a 
service 

(7) "On site Certification Review" means a f©- 
view process through which compliance 
with applicable rules » a» area operated 
component is evaluated at tee specific >*te 
©y- tee regional office staff; m a contract 
component, by tee aFea program staff. 
"Service" means the care, treatment, reha- 
bilitation or habilitation which is provided 
bv an area program. For the purpose of this 
document, the term "service" mav refer to 
one or more sites where the service is pro- 
vided or to a Svstem of Services as approved 
bv the Commission. 

£8} "Program Review Branch" means tee 
branch ef tee Quality Assurance Section ©f- 
tee Division which is responsible f-©F devel 
opmg tee process a«4 coordinating tee Fe- 
view el mental health, mental retardation 
a»4 substance abuse services provided by 



meet a particular need which is provided e+- 

teeF through operation by tee area program 

©f through its contract with a public ©f pFi- 

vate agency. P©f tee purpose ©f certification 

aft©, decertification. aFea program manage 

m e nt services aFe considered te ©e a com 

ponent. aft©, each component stands as a 

separate e ntity. "Decertification" means the well as other applicable rules ©t tee Com 



aFea programs aft4 their contract agencies. 
(-P-f "R.evi e w Process" means a process t© 
monitor components f©F compliance with 
tee required quality assuranc e activiti e s as 



68 



6:2 KORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



miooion a«4 the Secretary » aocordanco 
, v j t h Q s. 122C 101(d) a»4 the s4es ef this 
Sootion. 

Statutory Authority G.S. 122C-1I3; 

122C-14I(b); I22C-142(a); 122C-l91(d). 

.0126 GENERAL PROVISIONS 

(a) All area-operated and contract components, - 
including at! physical locations, contracted ser- 
vices of an area program shall be reviewed for 
compliance with the applicable rules of the 
Commission and the Secretary. The review shall 
be conducted in accordance with the rules in this 
Section. Following full certification, each com 
ponont service shall continue to be reviewed, at 
a minimum, once during every biennial triennial 
review cycle. 

(b) Each component service shall havo either 
temporary, provisional, »f toft c e rtification he 
certified in order to receive state and federal 
funds. 

(c) A facility subject to licensure shall not serve 
clients until properly licensed in accordance with 
applicable statutes and rules. 

(d) The rules used' in any review for certif- 
ication shall be the applicable rules as codified in 
10 NCAC 181 through 18Q and other applicable 
rules of the Commission and the Secretary. 

f4^ A f*4e shall be judg e d as "met" wh e n: 
fA-> the rale was clearly met; &f 
f&i the Bile was set- completely met, b«t- 
toe corr e ction ef the out of compliance 
issu e ea» be easily a»4 quickly accom 
p fished a«4 there is evidence el efforts to 

Otherwise, a rale shall be judged '.not met." 



m 



A rale may- be judged "not applicable" 
only whon it- allows options ef non 



applicability e* waiver as otherwise pro 
vided by- law-r 

(e) On-site review and the written certification 
report for an area-operated component service 
are the responsibility of the regional director with 
participation by- the Raleigh office as needed. 
Division. On-site review and the written certif- 
ication report for a contract component con- 
tracted service are the responsibility of the area 
director with participation by the r e gional offic e 
Division as needed. Written certification reports 
shall be » toe format sp e cified i» Division Pub 
hcation APSM ' 10 1 "R e vi e w Process fof Area 
Programs a»4 Their Contract Ag e ncies". Thes e 
referenced rules have been adopted » accordanc e 
wtthGrS, 150B 11(c). 

(f) Reviews conducted for the purpose of con- 
tinuing certification shall be accomplished 



through a biennial self- triennial survey as de- 
scribed in Rule .0130 of this Section. 

(g) The regional dir e ctor a»4 division director 
Division shall be responsible for approval and 
issuance of certification for area-operated com 
ponents. services. 

(h) The area director and regional director the 
Division shall be responsible for approval and 
issuance of certification for contract compon e nts. 
contracted services. 

"7n The" regional director Division shall notify 
the area director in writing when an area- 
operated component's serviced certification is 
denied or changed or when the component ser^ 
vice is decertified. The written notification shall 
give the reasons for such action and the right to 
appeal the decision according to Rule .0135 of 
this Section. The area director shall provide the 
same notification to the contract contracted pro- 
vider or agency director when such action in- 
volves a contract componont. service. 

(j) In addition to the review procedures pre- 
scribed in this Section, other reviews may be 
conducted as follows: 

(1) The Division director may, at any time, 
authorize an on-site review of any com 
ponont. service. 

(2) Any area-operated or contract component 
contracted service may, at any time, with 
the approval of the area director, request 
an on-site review from its respective re- 
gjonal offico the Division for the purpose 
of consultation and technical assistance. 
Such reviews shall Retr however, exempt 
toe componont from However, the Divi- 
sion's responsibility in recognizing com- 
pliance with all other rules of this Section 
remains. 

(3) An area director may request approval of 
a System of Services, in the format ap- 
proved bv the Commission, for supervised 
independent living, alternative residence 
and companion sitter. 

Statutory Authority G.S. 122C-1I3; 

122C-l4I(b); l22C-142(a); 122C-191(d). 

.0127 CERTIFICATION 

(a) The area program shall submit an applica- 
tion for temporary 1 certification for oach Hew- e* 
uncertified component ef i» situations requiring 
a» on site review a service, as specified in this 
Rule .013 ' 1 ef this Section on the Division's 
"Application for Temporary Certification" form. 
which fftay- be obtained from the regional offic e . 

(b) The area program shall submit the appli- 
cation to the regional offico Division for all new 
components services at least 30 days prior to: the 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



69 



PROPOSED RULES 



receipt ef a»v divisional funds, including start up 
funds. 

provision of service to a client in an un- 

certified service; 



change in provider for an existing service; 
or 

change of location if requested by the re- 
gional director. 

Application for Temporary 



ill 

(Jl 
(Jl 

(c) An approved 
Certification" serves as the notice of temporary 
certification. Temporary Certification shall be 
granted upon a determination by the Division 
that sufficient data has been provided by the ap- 
plicant and there is reasonable assumption that 
the applicant will be able to fully perform all 
obligations pursuant to the temporary certif- 
ication. 

(4+ A temporary certification shall ae* exceed 
si* months. 

fe4 (d| If the component service appeals the de- 
nial of temporary certification, funds shall not be 
available to the component service unless it 
agrees to meet the Division requirements pending 
the outcome of the appeal. 

(e) Certification shall not begin prior to the 
date of application for certification. 

( f) Prior te expiration ef t e mporary certification. 
a» on site certification review shall he conducted, 
following which provisional certification » ac- 
cordance with Rulo .012S ef this Section ef fott 
certification m accordance with Rule .012^ ef this 
Section may he granted ef the component may 
he decertified » accordance with Rule .0132 ef 
th+s Section. An on-site review of a service 
which has been initially approved shall be com- 
pleted within six months of the date of applica- 
tion. 

(g) A component shall (*et- receive twe consec 
utivo temporary cortificationo. During the six 
months following application, the appropriate 
staff shall provide consultation and technical as- 
sistance to the service provider in order to famil- 
iarize the provider with applicable statutes and 
rules. 

Statutory Authority G.S. I22C-113; 

1 22C- 141(b); I22C-142(a); 122C- 191(d). 

.0128 OLT-OF-COMPLIANCE FINDING 

(a) Provisional certification shall he granted at 
a»y- tune whan: 

i-b} a component is found te he out of 
compliance with e«e ef more applicable 
rules which 4e set present as immediate 
throat te the health, welfare ef safety ef 
the individuals served; ef 
(-54 a compon e nt subject te- licensure is pfe- 
visionallv licensed. 



fh+ Provisional certification shall not exceed si* 
months. 

(e) During the provisional certification period, 
the regional director shah provide) consultation 
aft4 technical assistance te the area operated 
components, if indicated. te correct any areas ef 
non compliance: the afea dir e ctor shall provide 
such consultation aft4 technical assistance te 
contract components. 

(4) During the provisional certification period, 
the area director shah submit a statement fef re- 
view etf¥i approval hy- the regional director a»4 
division director describing the corrective action 
taken by a component. 

fe} V i Tton ah out of complianco ef provisional 
licensure issues are fully rosolvod ae4 docu 
mented, a f-»h certifioation shall he issu e d. 

f£} if ah out of compliance e* licensure issues 
afe eet fully resolved aft4 documented, a notice 
shall he se»t te the afea director ^0 days prior te 
e xpiration ef the provisional certification that 
decertification procedures wih he initiated by the 
regional offic e unless a request fof waiver ef a 
fthe has been approved. 

fs} A component shall net- r e ceiv e twe con 
oecutive provisional certifications. 

(a) When a service is found to be out-of- 
compliance with one or more applicable statutes 
or rules which do not present an immediate 
threat to the health, welfare or safety o[ th_e_ indi- 
viduals served, the area program shall show evi- 
dence that action iSj or will be, taken to correct 
all out-of-compliance findings. fhis is accom- 



plished through the development of a corrective 
action plan. 

(b) The area director shall submit a corrective 
action plan within 30 days of written notification 



of out-of-compliance findings for review and ap- 
proval by the Division. If not approved, the 
Division returns the plan to the area duector for 
further resolution. 

(c) When out-of-compliance findings are doc- 
umented, the Division shall provide consultation 
and technical assistance to the area program ser- 
vice, if requested. The area director shall be re- 
sponsible for contracted services, but mav request 
assistance from the Division. 

(d) The time allowed for the corrective action 
to be taken mav not exceed six months unless 



there is good cause as determined and 
bv the Division. 



ap_£ 



roved 



(e) When out-of-compliance issues are fullv 
resolved with supporting documentation, a letter 
shall be sent to the area board chairperson and 
the area director from the Division stating that 
all issues are resolved. 



(Jl If out-of-compliance issues are not fullv re- 
solved and it is felt bv the Division that there is 



70 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



not evidence that acceptable action is being taken 
to correct the out-of-compliance findings, a letter 
shall be sent to the area board chairperson and 
area director from the Division stating that de- 
certification procedures will be initiated. 

Statutory Authority G. S. 122C-I13; 
122C- 141(b); l22C-142(a); I22C-I9l(d). 

.0129 FULL CERTIFICATION (REPEALED) 

Statutory Authority G.S. 122C-I13; 

122C-14l(b); !22C-142(a); 122C-l91(d). 

.0130 TRIENNIAL REVIEW 

fa-)- Hach afea program an4 its area operated 
a«4 contracted components which a*e certified 

■t f j-t T tl-in J'*'-. i->4 . t r, i ilfit ■ i nt tVj^i QlLjj^, « n lliir ^^^^l^^^xi 
E^J ^^T 1 1 1U CTTT^TTT^ UUIU IT 1 E 1 11^ 1 *_i I\J LT 11 1 L 1 I_ILT L f W 1 H r u 

may continuo cortificution by participation i» a 
biennial oolf survey as doooribod m this Rulo. 
fb} ¥he regional dir e ctor shall soloct a«4 notify 

two year self gafvey cycle. 

fe) : Fhe area director shall appoint a self survey 
coordinator who must participate i» a training 
session e» the self survey process. 

(4} -By the- date specified by foe regional diroc 
tefr foe area director shall: 

f-b) onsur e that self survey check sheets hav e 
been completed by each component with 
participation ef component staff; 
f2} onsure that- the Inventory ef Services is aft- 
accurate reflection ef all sorvioos provided 
at the time el foe self surv r oy; 
(4} prepar e a composit e report fef review a»4 
approval by the r e gional director consist 
fog ef the following: 
fA} a list ef all components which were fo 

foil compliance; 
f&) a list ef components having unresolved 
non compliance issues including foe iden 
tificatiun ef rules "not met" by each indi 
vidual component; 
fG) a list ef components fof which decer 
tification is fo proc e ss, if anyr a«4 reason 
let such action; aed- 
fB} a statement fo foe format specified fo 
APSM 10 1 an4 signed by foe afea direc 
te? atfo tbe area board chairperson Fe- 
flecting that the information provid e d is a 

status el the area program ajfo its com 

pononts; a«4 
(4) transmit the following te the regional di- 

rector: 
(A-) signed composit e report; ami 
fft) a copy ef all completed chock sheets. 



(e) Appropriate cortificationo shall be issuod 
based upon review an4 approval ef the itomo fo 
(4)ef tbis Rule. 

(a) Area programs shall maintain certification 
by participation in a triennial, on-site, certif- 
ication review process as described in this Sec- 
tion. 

(b) At least 60 days, but not more than 180 
days, prior to the on-site review, the area director 
shall assure that: 

(1) the Inventory of Services, which is pro- 
vided by the Division, is an accurate re- 
flection of its current area-operated and 
contracted services; and 

(2) all area-operated and contracted services 
are reviewed and a statement of compli- 
ance or a corrective action plan is sub- 
mitted to the Division. 

(c) The area director shall be responsible for 
corrective actions which address out-of- 
compliance findings identified during the review 
as described in Rule .0128 of this Section. 

Statutory Authority G.S. 122C-113; 

1 22C- 141(b); 122C- 142(a); 122C- 191(d). 

.0131 ON-SITE VALIDATION PROCESS 
(REPEALED) 

Statutory Authority G.S. 122C-113; 

122C-I41(b); 122C-142(a); 122C-l9l(d). 

.0132 DECERTIFICATION 

(a) Decertification of a component service shall 
be initiated: 

(1) immediately upon confirmation that a 
component service subject to licensure is 
not licensed; 

(2) immediately upon notification by the li- 
censing agency that the license for a com 
ponent service has been revoked; 

(3) immediately when there is substantiated 
evidence of conditions which threaten the 
health, safety or welfare of individuals 
served; 

Ml n-i<tiitA 1 I I , 1 ■ 1 1 I >■• r\ni a r t a t \~i . t , \ i.- t~. I r ■ i t I i \ n , i I f 1 i . | 

^~| TTTTTTTTT rTTT UU T -' \ ' 11 ' 1 \ VJ tTTC I. I\ I '11 Hill. Ml If I 1 1 IV 

provisional certification if the required 
corrective action stat e ment has Ret been 
submitted aft4 implemented; upon failure 
to complete corrective action in accord- 
ance with the approved plan; or 
(5) upon failure to participate in the biennial 
self- triennial survey, et the validation 
procoss. 

(b) If, after review of evidence, the Division 
director finds that a component service meets one 
or more of the conditions specified in Paragraph 
(a) of this Rule and that the appropriate proce- 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



71 



PROPOSED RULES 



dures have been followed by the Division, Divi- 
sion funds may be withheld as outlined in 10 
NCAC 14C .1013 until compliance is achieved 
as determined by the Division director. 

Statutory Authority G.S. I22C-113; 

l22C-I4I(b); I22C-142(a); 1 22C-191 (d). 

.0133 CHANGES IN STATUS 

(a4 A "Change In Status" form a* sp e cified m 
Division Publication APSM ' 10 1 "Roviow Proc 
ess fof iVroa Pro gram s a»4 Thau Contract 
Agencies" provided bv the Division shall be 
submitted immediately for a component service 
by the area director to the regional director Di- 
vision when a change occurs in information in 
the Inventory of Services, excluding those situ- 
ations requiring an on site roviow application for 
certification as specified in Rule .013 1(a) .0127(b) 
of this Section. These referenced rules have been 
adopted in accordance with G.S. 150B- 14(c). 

fkf I "pon validation e£ the change, the regional 
director shall forward the form to the Division. 

Statutory Authority G.S. 122C-113; 

122C- 141(b); !22C-142(a), ■' 122C- 191(d). 

.0134 SITUATIONS REQUIRING ON-SITE 

CERTIFICATION REVIEW (REPEALED) 

Statutory Authority G.S. 122C-113; 

122C-14/(bj; 122C-142(a); 122C-19I(d): 

.0135 APPEALS AND WAIVERS 

(a) Area boards may informally appeal to the 
Division's actions Division director regarding 
certification and the withholding of Division 
funds. Formal appeals may be requested in ac- 
cordance with according to the procedures speci- 
fied in accounting rule 10 NCAC 14C .1013 and 
the rules for contested cases as codified in 10 
NCAC 14B, Section .0300. 

(b) Area boards may request a waiver of aa 
individual ft4e ef rules by submitting a written 
request to the Division director, if the Com 
mission, secretary ©f division director grants a 
waiver sf a rule. If a rule has been waived bv the 
proper authority, the program shall be exempt 
from review of the rule, fef which the waiv e r 
v^as grant e d. 

Statutory Authority G.S. 122C-1I3; 

122C-I41(b); I22C-142(a); 122C-191(d). 

****************** 



Ivotice is hereby given in accordance with G.S. 
150B-/2 that the DHR - Division of Aging intends 
to adopt rules cited as 10 NCAC 22J .0101 - 
.0/04, .0201, .0301 - .0310. 

1 he proposed effective date of this action is Au- 
gust 1, 1991. 

1 he public hearing will be conducted at 2:00 
p.m. on May 15, 1991 at the S.C. Division of 
Aqing, 693 Palmer Drive, Room 127, Raleigh, NC 
2~603. 

{comment Procedures: Written comments con- 
cerning the proposed regulations must be submit- 
ted by May 15, 1991 to: Gary H. Cyrus, Division 
of Aging, Caller Box Number 29531, 693 Palmer 
Drive, Raleigh, \C 27626-0531 . Oral presenta- 
tions may be presented at the hearing. Any person 
may request information or copies of the proposed 
regulations by writing Mr. Gary Cyrus at the 
aforementioned address or by calling him at (919) 
733-8399. 

CHAPTER 22 - AGING 

SUBCHAPTER 22J - IN-HOME AIDE SERVICES 
FOR OLDER ADULTS 

SECTION .0100 - SCOPE OF SERVICE 

.0101 SCOPE OF IN-HOME AIDE SERVICES 

As used in this Subchapter, the following defi- 
nition of In- Home Aide Services shall apply: 

(1) Primary Service. In- Home Aide Services 
are those paraprofessional services which 
assist the individual, his family or both with 
essential home management tasks, personal 
care tasks, or supervision, or all of the 
above, to enable the individual, his family, 
or both to remain, and function effectively, 
at home as long as possible. 

(2) Respite Care Component. In- Home Aide 
Services may be used for the purpose of 
providing respite for a primary caregiver. 
For this purpose, In- Home Aide Services 
may be provided to a client or patient in his 
own home or in the home of his primary 
caregiver. Respite Care may consist of any 
level of home management or personal care 
tasks. 



Statutory Authority 
1 43 B- IS 1.9 A. 



G.S. I43B-I81.1(c); 



.0102 DEFINITIONS 

As used in this Subchapter, the following terms 
shall have the meanings specified: 



72 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



(1) "Activities of Daily Living (ADL)" include 
eating, dressing, bathing, toileting, bowel 
and bladder control, transfers, ambulation 
and communication such as speaking, the 
written word, signing, gestures and commu- 
nication devices. 

(2) "Available Person" is someone who lives 
with or near the client, who has the time and 
is willing to perform the needed services. 

(3) "Primary Caregiver" is the person who 
voluntarily provides the most care or as- 
sumes the most responsibility for another 
person. 

(4) "Home Management" includes tasks that 
range from basic housekeeping, shopping, 
and essential transportation to intensive 
work with individuals and their families on 
budgeting and family management. 

(5) "Instrumental Activities of Daily Living 
(IADL)" includes meal preparation, 
medication intake, cleaning, money man- 
agement, phone use, laundering, reading, 
writing, shopping and going to necessary 
activities. 

(6) "Medically Stable" means physical or 
mental adaptation to previously recognized 
health problems with effective maintenance 
by diet, medication, or routine physical ex- 
ercise, or a combination of these remedies. 

(7) "Medically Unstable" means a recent acute 
illness or complications of a chronic condi- 
tion that are not physically or mentally 
controlled by diet, medication, or physical 
exercise, or a combination of these remedies 
and which require frequent monitoring and 
testing by skilled professionals. 

(8) "Older Adult" means 60 years of age or 
older. 

(9) "Own Home" means that the service re- 
cipient is living in a residence he maintains 
for himself or is maintained for him. "Own 
home" does not include any group care set- 
ting. 

(10) "Personal Care" includes tasks that range 
from assistance with basic personal hygiene 
and grooming, feeding, and ambulation to 
medical monitoring and other health care 
related tasks. 

(11) "Respite Care" is a component of In- 
Home Aide Services which provides needed 
relief to primary caregivers of persons who 
cannot be left alone because of mental or 
physical problems. 

(12) "Responsible Person" is someone who is 
dependable and capable of performing the 
needed services for the client. 



Statutory Authority 
1 43 B- 18 1.9 A. 



G.S. I43B-I81.l(c); 



.0103 DESCRIPTION OF IN-HOME AIDE 
SERVICE LEVELS 

As used in this Subchapter, the following de- 
scriptions of In- Home Aide Service levels shall 
apply for older adults: 

(1) Level I - Home Management. In- Home 
Aide Services at this level are intended to 
provide support to persons and their families 
who require assistance with basic home 
management tasks, such as housekeeping, 
cooking, shopping, and bill paying. Clients 
to be served include those who are self- 
directing, medically stable, and who have at 
least one instrumental activity of daily living 
(IADL) impairment. Personal care tasks 
may not be performed at this level. 

(2) Level II - Home Management and Personal 
Care. In- Home Aide Services at this level 
are intended to provide support to persons 
and their families who require assistance 
with basic activities of daily living and home 
management tasks. Both the home man- 
agement and assistance with personal care 
tasks can be provided to the client when his 
capacities are dirninishing or when the client 
is striving to maintain or improve his own 
functioning. Clients to be served include 
those who are medically stable and partially 
dependent in carrying out one or two activ- 
ities of daily living (ADL) due to physical 
or mental impairments, or both; or who 
have maintenance needs or rehabilitative 
potential, or both. In addition to their per- 
sonal care needs, clients may also require 
assistance with IADL activities to improve 
IADL functioning or to learn independent 
living skills; or they may have two to four 
IADL needs requiring additional support to 
maintain or achieve overall functioning. 

(3) Level III - Home Management. In-Home 
Aide Services at this level are intended to 
provide intensive education and support to 
persons and their families in carrying out 
home management tasks and improving 
family functioning skills. Provision of the 
service primarily focuses on individualized 
work with a client and his family in teaching 
and demonstrating skills and tasks and rein- 
forcing improved client and family accom- 
plishments. It also involves direct care and 
support in crisis situations. Clients to be 
served generally have moderate to severe 
limitations in cognitive or psycho-social 
functioning, but have potential for partial 
or total independence in IADL or home 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



73 



PROPOSED RULES 



management functioning, or both. Some 
clients may have more than four IADL 
impairments. 

(4) Level III - Personal Care. In-Home Aide 
Services at this level are intended to provide 
substantial ADL support to persons who 
require assistance with health or personal 
care tasks, or both. Provision of these tasks 
involves extensive "hands on" care and po- 
tential assistance with a wide range of health 
related conditions. Clients to be served in- 
clude those who are medically stable with 
three or more ADL impairments resulting 
from a chronic condition; or who are med- 
ically stable with significant ADL impair- 
ments, but have rehabilitative potential; or 
who are medically unstable due to recent 
illness, complications of a chronic condition, 
or a deteriorating condition with variable 
ADL and IADL needs. 

(5) Level IV - Home Management. In-Home 
Aide Services at this level are intended to 
provide a wide range of educational and 
supportive services to persons and their 
families who are in crisis or who require long 
term assistance with complex home man- 
agement tasks and family functioning skills. 
Provision of the service involves quick and 
creative response to individual and family 
crisis situations identified by the case man- 
ager; it also focuses on appropriate learning 
sessions with small groups of persons from 
different families who have similar needs. 
Clients to be served include those who have 
serious limitations in cognitive or psycho- 
social functioning, or both, but who have 
the potential for major or complete inde- 
pendence in IADL functioning and who 
have little or no ADL impairment. 



Statutory Authority 

MSB- IS 1.9 A. 



G.S. I43B-I81.1(c); 



.0104 TARGET POPULATION 

The target population consists of individuals 
who are unable to carry out tasks essential to the 
activities of daily living or the instrumental ac- 
tivities of daily living, or both, who have no re- 
sponsible person available to perform these tasks, 
and who need the service in order to remain in 
their own homes. It also includes functionally 
impaired persons whose primary caregivers need 
relief from everyday caregiving responsibilities in 
order for the impaired individuals to remain at 
home. 



SECTION .0200 - CLIENT ELIGIBILITY 

.0201 ELIGIBILITY FOR IN-HOME AIDE 
SERVICES 

(a) Persons eligible for services must be 60 
years of age or older, live at home, and have 
home management or personal care needs, or 
both. 

(b) Persons served must be in need of the ser- 
vice for all of the following reasons: 

(1) the person is unable to carry out one or 
more tasks essential to the activities of 
daily living (ADL's) or instrumental ac- 
tivities of daily living (IADL's); 

(2) the person needs help with these tasks in 
order to remain in his own home; and 

(3) a responsible person is not available to 
perform these tasks or the primary 
caregiver needs relief. 

(c) Persons must be served in the following 
order of priority: 

(1) older adults for whom the need for Adult 
Protective Services has been substantiated 

- and the service is needed as part of the 
adult protective services plan; 

(2) older adults who are at risk of abuse, neg- 
. lect, or exploitation; 

(3) older adults with extensive ADL or IADL 
impairments who are at risk of placement 
in substitute care; 

(4) older adults with three or more ADL or 
IADL impairments; and 

(5) older adults with one or two ADL or 
IADL impairments. 



Statutory Authority 
MSB- 18 1.9 A. 



G.S. 143B-I81.1(c); 



SECTION .0300 - SERVICE PROVISION 

.0301 SERVICE DELIVERY 

In- Home .Aide Services must be provided in 
accordance with the standards established in 
Rules .0304, .0305, .0306, .0307, and .0310 of this 
Section for task levels, competency requirements, 
supervision, and quality assurance requirements 
regardless of whether the aide performing the 
tasks is a paid employee or a volunteer under the 
supervision of an established agency. 



Statutory Authority 
MSB- 18 1.9 A. 



G.S. MSB-lSl.l(c); 



Statutory Authority 
MSB- 18 1.9 A. 



G.S. MSB- 181.1 (c); 



.0302 ASSESSMENT AND REASSESSMENT OF 
CLIENT 

(a) The purpose of the initial assessment and 
regular reassessments is to determine each client's 



74 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



level of functioning and determine or confirm the 
need for In- Home Aide Services. 

(b) The initial assessment and reassessments 
must be conducted by an appropriate profes- 
sional and are prerequisites to providing In- 
Home Aide Services. 

(c) An initial assessment is not a prerequisite 
when the health or safety of a client is at risk. 
In these instances the initial assessment must be 
completed within five working days of the onset 
of services. 

(d) The initial assessment and reassessment 
must be conducted in the client's home and must 
address the mental, social, environmental, eco- 
nomic, and physical health status of the client, 
as well as the ability to perform activities of daily 
living (ADL's) and instrumental activities of daily 
living (IADL's). 

(e) The initial assessment and reassessments 
must be signed and dated by the professional re- 
sponsible for assuring the completion of the ini- 
tial assessment and reassessments. 

(f) An initial assessment must be completed 
prior to the professional's development of an In- 
Home Aide Service Plan. 

(g) A full reassessment must be completed at 
least every 12 months or as the client and family 
situation warrants. 

(h) A review of the client and family situation 
must be completed by an appropriate profes- 
sional at least quarterly. If a reassessment is 
conducted, it meets the requirements for a quar- 
terly review. 

(i) If the person needs Home Management 
tasks at Levels I, II, or III, the initial assessment 
and reassessments must be completed by a social 
worker or other appropriate professional such as 
a registered nurse or registered dietitian. If a 
registered nurse or dietitian is conducting the in- 
itial assessment or reassessment at Levels I, II, 
or III, and the client's social needs appear more 
extensive than the assessor is able to adequately 
evaluate, then a social worker must be consulted 
for further input. If the person needs Home 
Management tasks at Level IV, the initial assess- 
ment and reassessments must be completed by a 
social worker. 

(j) If the client needs Personal Care tasks at 
Level III, a registered nurse must complete the 
physical health status and the ADL portions of 
the initial assessment and reassessments. For 
Level II Personal Care tasks, if a social worker 
or registered dietitian is conducting the initial as- 
sessment or reassessment and the client's per- 
sonal care needs appear more extensive than the 
assessor is able to adequately evaluate, then an 
appropriate health professional must be con- 
sulted for further input. 



Statutory Authority G.S. 143B-18I.I (c); 
143B-1S1.9A. 

.0303 IN-HOME AIDE SERVICE PLAN 

(a) Each client must have an In- Home Aide 
Service Plan which is based on the initial assess- 
ment and regular reassessments. 

(b) The In- Home Aide Service Plan must in- 
clude: 

(1) measureable client outcome goals; 

(2) In- Home Aide Service level or levels to 
be provided; 

(3) specific tasks to be performed; 

(4) frequency of service provision; 

(5) anticipated duration of the service; condi- 
tions for continuing or discontinuing ser- 
vice; 

(6) signature of client or designated person 
indicating agreement with the service plan; 

(7) signature of agency's professional staff de- 
veloping the service plan; and 

(8) a physician's signature if required by a 
specific funding source. 

(c) All changes in tasks must be documented 
and dated on the In-Home Aide Service Plan by 
the responsible professional. 

Statutory Authority G.S. 143B-181 .1 (c); 
143B-18I.9A. 

.0304 COMPETENCY REQUIREMENTS 

(a) Aides who provide In-Home Aide Services 
must meet the competency requirements for the 
level of service they are regularly required to 
perform. In addition, an aide performing any 
tasks in Level III Personal Care must meet the 
competency requirements for that level and be 
registered as a Nurse Aide I with the NC Board 
of Nursing. Meeting competency requirements 
includes a correct demonstration of the tasks to 
an appropriate professional. 

(b) The agency employing the in-home aides 
must maintain documentation of each aide's 
competence; this includes verification of know- 
ledge of all content areas and ability to correctly 
perform all tasks at the level of service regularly 
provided. If the aide is required to perform se- 
lective tasks at a higher level, documentation of 
competence in the specific tasks is also required. 
An aide must be fully competent at the current 
level of service provision before being assigned 
tasks at a higher level. 

(c) By July 1, 1991, regardless of the level of 
service to which the aide is assigned, demon- 
strated competence for the specific tasks assigned 
to that aide must be documented before allowing 
the aide to perform the tasks independently. 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



'5 



PROPOSED RULES 



(d) Competency requirements for all levels ex- 
cept Level III Personal Care are applicable on 
July 1, 1993 for all persons hired after than date. 
All aides performing any Level III Personal Care 
tasks must have met the NC Board of Nursing's 
competency requirements and be registered as a 
Nurse Aide I with the North Carolina Board of 
Nursing by January 1, 1991 or within four 
months of being assigned these tasks. Each ser- 
vice provider agency is responsible for ensuring 
that competency testing is appropriately admin- 
istered. 

(e) A listing of the tasks and related areas of 
competence for each level from which a compe- 
tency test for the aide will be drawn is provided 
in Rule .0305 of this Section. 

(f) Each service provider agency is responsible 
for insuring that its aides have sufficient training 
to pass a competency test for the level of service 
the aides will regularly provide. 



(g) In the event that a spouse, parent, child or 
sibling is paid to provide care, the service pro- 
vider agency can make a determination that the 
family member is capable of providing the care 
needed without requiring any formal training. 
The family member must demonstrate compe- 
tence to perform the tasks needed by the client 
to an appropriate professional. When the family 
member provides Personal Care at Level III, he 
must meet the NC Board of Nursing's compe- 
tency requirements and be registered as a Nurse 
Aide I with the NC Board of Nursing within four 
months of being assigned these tasks. 

(h) Demonstration of competence in the pres- 
ence of an appropriate professional can take 
place in a variety of settings including, but not 
limited to, the classroom, laboratory, local 
agency, or the home of the client and family. 



Statutory A uthoritv 
1 43 B- 18 1.9 A. 



G.S. 143B-181.1(c); 



.0305 IN-HOME AIDE TASKS AND REQUIRED COMPETENCIES 

(a) Tasks to be performed and required competencies for In-Home Aides performing Level I 
Management are as follows: 



Home 



Tasks 



Required Competencies 



Home Management 



• Pay bills as directed by client 

• Provide transportation for 
medical appointments and shopping 

• Clean and care for clothing: 
ironing, simple mending, 
laundering 

• Do basic housekeeping tasks: 
sweeping, vacuuming, dusting, 
mopping, dishes 

• Make minor repairs to house and 
furnishings 

• Make un-occupied bed 

• Recognize and report changes in 
health and environment 

• Identify medications for client 

• Provide companionship and 
emotional support 

• Prepare simple meals 

• Shop for food from verbal or 
written instruction 

• Observe and report symptoms of 
abuse, neglect, and illness to 
proper professional 



Communication Skills 

• Methods of communication 

• Maintaining control 

• Observing, documenting and 
reporting 

• Confidentiality 

Mental Health and Illness 

• Characteristics of good 
mental health 

• Personality differences 

Family Dynamics 

• Cultural and Ethnic Life- 
styles 

• Role of families in 
meeting individual needs 

Home Management Skills 

• Maintaining a clean and 
safe environment 

• Basic housekeeping 

• Shopping 

• Clothing care and repair 

• Paving bills 



Food and Nutrition 
• Role of nutrition in 



~h 



6:2 XORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



promoting good health 

• Balanced meal preparation 
and food handling and 
storage 

Disabled Adults 

• Life long aging process 

• Disabled persons as 
individuals 

• Specific needs of older persons 

Understanding Basic Human Needs 

• Physical and psychological needs 

• Needs hierarchy 

• Client and Patient Rights 

Medications 

• Retrieve and identify 
medications for client 

• Do's and don'ts of medication 

Responding to Emergencies 

• Fire 

• Personal injury and sickness 

• Observe and report systems 
of abuse, neglect, exploitation, 
illness, or unsafe environment 
to proper professionals 

• Other dangers 

Personal Hygiene (worker) 

• Expectations regarding 
cleanliness, odors, smoking 

Safety Measures 

• Household safety tips 

• Body mechanics for aides 

• Transporting of client 

Inappropriate Tasks 

• Personal care 

• Deviation from care plan 

• Other inappropriate tasks 

(b) Tasks to be performed and required competencies for In-Home Aides providing Level II - Home 
Management and Personal Care are as follows: 

Tasks Required Competencies 

Home Management 

Communication Skills 

• Assist in following budget • Roles of the service 
prepared by case manager delivery team 

• Assist to find and use • Plan of care 
community resources • Report writing 

• Perform reading and writing 

tasks Mental Health and Illness 



6:2 NORTH CAROLINA REGISTER April 15, 1991 77 



PROPOSED RULES 



• Demonstrate and model simple 
altering and mending techniques 

• Demonstrate and model 
housekeeping 

• Assist in organizing household 
routines 

• Assist in making or purchasing 
clothing or other household items 

• Plan menus using food guide 

• Assist with developing a market 
order and shopping 

• Demonstrate and model food 
handling, preparation and storage 

Personal Care 

• Assist ambulatory client with 
mobility and toileting 

• Provide care for normal, 
unbroken skin 

• Assist with personal hygiene, 
(mouth care, hair and scalp 
grooming, fingernails and 
bathing; shower, tub, bed, basin) 

• Cut and trim hair 

• Shave client (electric and 
safety razor) 

• Provide basic first aid 

• Apply ace bandages. TED's, 
binders (demonstrated competency 
verified by R.N.) 

• Make occupied bed 

• Assist limited function patient 
with dressing 

• Observe, record and report 
self- administered medications 

• Apply and remove prosthetic 
devices for stable clients 
(demonstrated competencv verified 
by R.N.) 

• Assist with feeding clients with 
special conditions (no swallowing 
difficulties) 

physical activity and 

• Assist and encourage physical 
activity and prescribed exercise 

• Assist client with self- 
monitoring of temperature, pulse, 
blood pressure and weight 
(demonstrated competencv verified 
by R.N.) 



• Effects of stress 

• Defense mechanisms 

• Dementia 

family Dynamics 

• family life cycle 

• Issues at each stage of life 

• Effects of disruption 

Home Management Skills 

• Housekeeping techniques 
and routines 

• Demonstrating and modeling 
homemaking tasks 

• Working within a budget 

• Clothing and household 
supply purchasing 

• Knowledge and use of 
community resources 

Food and Nutrition 

• Planning menus from a food 
guide 

• Developing a market order 

• Principles of food 
preparation 

• Following a prescribed 
diet 

111 and Disabled Adults 

• Diseases of the elderly 

• Copmg with chronic 
illness 

Special Care Skills 

• Assist with feeding 
clients with special 
conditions (excluding 
swallowing difficulties) 

• .Application of ace 
bandage, TED's, binders 

• Assist and encouraae 



prescribed exercise 

• Assist ambulatory client 
with mobility and toileting 

• Assist limited function 
client with dressing 

• Making occupied bed 

• Assist with application 
and removal of prosthetic 
devices 



Personal Hygiene (client) 

• Assist with bathing (bed, 
tub, shower, basin) 

• Assist with mouth care 



78 



6:2 KORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



• Assist with hair and 

scalp grooming (cut and trim 
hair) 

• Assist with fingernail 
care (clean and file) 

• Shaving clients (electric 
and safety razor) 

• Normal skin care 

Medications 

• Reminding and reinforcing 
self-administered 
medications 

• Observe, report, record 
self-administered 
medications 



Abuse and Neglect 

• Recognizing and reporting 
criteria (age specific) 

Infection Control 

• Preventing the spread of 
diseases 

• Hand washing techniques 

Basic First Aid 

• Principles of cardio- 
pulmonary Resuscitation 

• Taking temperature, pulse, 
height and weight 

• Taking blood pressure 

Inappropriate Tasks 

(c) Tasks to be performed and required competencies for In-Home Aides providing Level III 
Management and Level III - Personal Care are as follows: 



Home 



Tasks 

Home Management 

• Demonstrate securing and caring 
for household furnishing 

• Teach basic sewing and use of 
sewing machine 

• Demonstrate how to plan for a 
move, locate housing, and organize 
moving activities 

• Teach and reinforce house- 
keeping methods, home safety, 
energy conservation, and 
sanitation skills 

• Teach and reinforce personal 
hygiene and self care, reinforce 
sound health care practices, and 
personal safety techniques 

• Take and accompany to medical 



Required Competencies 



Communication Skills 

• Promoting client 
independence 

• Strategies for guiding, 
supporting, and encouraging 

• Medical terminology 

• Documentation 

Mental Health and Illness 

• Substance abuse 

• Mental retardation 

• Types of mental disorders 

Principles of Adult Education 

• How Adults Learn 

• "Let's Do" teaching 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



-9 



PROPOSED RULES 



appointments; reinforce special 
diet routines; monitor treatment 
plans 

• Teach and reinforce household 
budgeting and planning skills; 
teach proper use of credit 

• Demonstrate and reinforce 
comparison shopping and good 
consumer practices with food, 
clothing and furnishings 

• Teach and reinforce management 
of time and resources, including 
work simplification techniques 

• Teach and reinforce appropriate 
food handling and cooking skills 

• Monitor and reinforce family 
progress on protective service 
plan goals 

Personal Care 

(Tasks subject to nurse 
supervision requirements of the 
Nursing Practice Act.) 

• Assist with feeding clients 
with special conditions 

• Give bed bath 

• Make occupied bed 

• Assist with mobility, gait 
training using assistive devices 

• Assist with range of 
motion exercises 

• Assist limited function patient 
with dressing 

• Take and record temperature, 
pulse, blood pressure, height and 
weight, respirations 

• Observe, record and report 
self-administered medications 

• Apply and remove prosthetic 
devices for stable client 

• Apply ace bandages, TED's, 
binders 

• Assist with scalp care 

• Trim toenails for clients 
without diabetes or peripheral 
vascular disease 

• Empty and record drainage of 
catheter bag 

• Shave clients with skin 
disorders 

• Administer enemas 

• Insert rectal tubes and flatus 
bags 

• Bowel and bladder retraining 

• Collect and test urine or fecal 
specimens 

• Perineal care 



Food and Nutrition 

• Comparison Shopping 

• Principles of therapeutic 
(specialized) diets 

• Purchasing, planning and 
preparing therapeutic 
(specialized) diets 

• Observing dietary 
treatment plans 

Infection Control 

• Isolation techniques 

• Universal precautions 

• Application in the home 

Death and Dying 
Personal Care Track 

Personal Hygiene 

• Bed bath 

• Shampoo in bed 

• Shave client with skin 
disorders 

• Trim toenails (no diabetes or 
peripheral vascular disease) 

• Perineal and catheter care 

Treatment Techniques 

• Assist with feeding 
clients with special 
conditions 

• Force and restrict fluids 

• Care of non-infected skin 
ulcers 

• Clean dressing changes 
(non-sterile) 

• Vaginal douches 

• Apply prescribed heat and 
cold 

• Assist client in 
understanding medical orders 
and routines, encourage 
compliance 

• Intake and output 

• Take respirations 

Elimination and Treatment 

• Empty and record drainage of 
catheter bag 

• Bowel and bladder retraining 

• Collect and test urine or 
fecal specimens 

• Insert rectal tube and 
flatus bag 

• Apply condom catheters 

• Administer enemas 

• Use of bedpans and urinals 



80 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



• Apply condom catheters 

• Chair and stretcher transfer 

• Turn and position 

• Safety measures (side rails, 
mitts, restraints) 

• Change non-sterile dressings 

• Force and restrict fluids 

• Apply prescribed heat and cold 

• Care for non-infected decubitus 
ulcers 

• Assist clients in understanding 
medical orders and routines, 
encourage compliance 

• Assist with purchase and 
preparation of diet food specified 
by professional 

• Vaginal douches after 
instruction 

• Assist with prescribed physical 
and occupational therapy 

• Plan menus for special diets 

• Monitor dietary treatment plan, 
provide feedback to professional 

Tasks With Special Training 
(Requires Nurse Aide II 
registration with the NC Board 
of Nursing) 

• Administer gastrostomy tube 
feedings 

• Perform in and out bladder 
catheterizations 

• Change sterile dressings 



Other Training Techniques 

• Apply and remove EKG 
monitor leads 

• Post mortem care 

• Gastric suction 
(maintenance) 

• Turn, cough and deep breath 

• Restorative services 

Body Mechanics 

• Transfer techniques 

• Use of lifts 

• Assistive devices 

• Assist with prescribed 
physical and occupational 
therapy 

Safety Measures 

• Side rails, mitts 
restriants 

Basic First Aid 

• Cardiopulmonary 
Resuscitation 

Home Management Track 

Home Management Skills 

• Teaching housekeeping skills 

• Planning and organizing 
moving activities 

• Energy conservation 

• Basic mending and sewing 
and use of sewing machine 

• Home safety skills 



Financial Management 

• Setting family goals 

• Developing a family budget 

• Making good budgeting and 
spending choices 

• Use of credit 

• Consumer protection practices 

Resource Management 

• Securing and caring for 
household furnishings 

• Teaching management of 
time and resources 

• Locating housing 

• Work simplification 
techniques 

Self Care 

• Personal hygiene and 
health care practices 

• Personal safety techniques 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



81 



PROPOSED RULES 



• Following treatment plans 

Family Dynamics 

• Understanding dysfunction 
in families 

• Impact of substance abuse 

• Reinforce new skills and 
patterns in poorly 
functioning families 

(d) Tasks to be performed and required competencies for In-Home Aides providing Level IV 
Management are as follows: 



Home 



Tasks 

Home Management 

• Provide supervision and role 
modeling of appropriate care and 
supervision when family is 
available but unable to perform 
caretaker duties due to physical 
or emotional illness (under close 
case supervision by social worker) 

• Implement strategies developed 
on social work plan including 
arranging transportation, housing 
and other auxiliary services 
(under close case supervision by 
social worker) 

• Demonstrate management of food 
resources and menu planning (under 
close case supervision by social 
worker) 

• Provide case tracking and follow 
up to social work staff by 
observing families in home 
environment 

• Assist professionals in 
establishing and maintaining 
various client groups 

• Provide tracking of household 
budgets with clients 

• Identify indicators of risks to 
families and appropriately report 
to social worker 



Statutory A uthority 
1 43 B- IS 1.9 A. 



G.S. 143B-lSl.l(c): 



.0306 TIME FRAMES FOR COMPLETING 
COMPETENCY REQL IREMENTS 

The following time frames for completing com- 
petency requirements for each level of In-Home 
Aide Services shall apply: 
(1) Level I. Competency requirements consist 
of demonstration of knowledge and skills 
indicated for Level I tasks listed in Rule 



Required Competencies 



Family Dynamics 

• Characteristics and 
interventions for multi 
problem families 

• Impact of loss, separation 

• Family violence 

• Confrontation skills 

• Principles of adult 
learning 

Home Management Skills 

• Planning moves 

• Understanding eviction 
procedures 

• Flimination of household 
safety hazards relevant to 
client functioning 

Protective Services 

• Fegal base and liability 

• Factors of increased risk 
for abuse or neglect 

• Indicators of mental and 
emotional functioning 



.0305 of this Section. Competency require- 
ments for Level I must be met within one 
year of employment as a Level I aide. 

(2) Level II. Competency requirements consist 
of demonstration of knowledge and skills 
indicated for Level II tasks listed in Rule 
.0305 of this Section. Competency require- 
ments for Level II must be met within one 
year of employment as a Level II aide. 

(3) Level III. This level is tracked for either 
I lome Management or Personal Care and 



82 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



shall consist of the following competency 
requirements: 

(a) Home Management Track. Competency 
requirements consist of demonstration of 
knowledge and skills indicated for Level 
III Home Management tasks listed in 
Rule .0305 of this Section. Competency 
requirements for Level III Home Man- 
agement must be met within one year of 
employment at this level. 

(b) Personal Care Track. Competency re- 
quirements consist of demonstration of 
knowledge and skills indicated for Level 
III Personal Care tasks and registration as 
a Nurse Aide I with the NC Board of 
Nursing. Level III Personal Care Tasks 
are listed in Rule .0305 of this Section. 
Aides performing Level III Personal Care 
tasks must complete training or compe- 
tency testing, or both within four months 
of employment at this level. 

(4) Level IV. Competency requirements con- 
sist of demonstration of knowledge and skills 
indicated for Level IV tasks listed in Rule 
.0305 of this Section. Competency require- 
ments for Level IV must be met within one 
year of employment as a Level IV aide. 



Statutory Authority 
143B-181.9A. 



G.S. 143B-181.1(c); 



.0307 AIDE SUPERVISION 

(a) It is the responsibility of the agency pro- 
viding the In- Home Aide Service to assure that 
supervision is given to all aides. 

(b) Regardless of the level of tasks performed, 
supervisory home visits must be made at least 
twice during the first month of the aide's em- 
ployment. 

(c) Following the first month of the aide's em- 
ployment, supervisory home visits must be made 
as follows: 

(1) Level I - at least quarterly; 

(2) Level II - at least quarterly; 

(3) Level III - at least every sixty days; and 

(4) Level IV - at least every' sixty days. 

(d) The frequency of aide supervision must be 
increased as needed to respond to the capabilities 
of the aide and the needs of the client. 

(e) Each service provider agency must assure 
at least some portion of the supervisory visits 
occur when the aide is providing care to clients. 



Statutory A uthority 
143B-181.9A. 



G.S. I43B-I8l.l(c); 



The following persons shall be allowed to serve 
as in-home aides: 

(1) Non-relatives who are 18 years of age or 
older who are qualified to perform the tasks 
needed by the client. 

(2) Relatives of the client, who for this purpose 
are parent, spouse, child or sibling, who are 
18 years of age or older and who give up 
employment or the opportunity for em- 
ployment in order to perform the service and 
who are qualified to perform the tasks 
needed by the client. 

Note: Persons who cannot serve as in-home 
aides are those under 18 years of age; those who 
are not qualified to perform the tasks needed by 
the client; and those who are relatives of the cli- 
ent, who for this purpose are parent, spouse, 
child, or sibling; who are unemployed or who do 
not have to give up employment in order to 
provide the service. 

Statutory Authority G.S. 143B-I8I .1 (c); 
I43B-181.9A. 

.0309 CLIENT RECORDS 

Records must be kept for each In- Home Aide 
Services client and must include: 

(1) documentation of request or authorization 
for services; 

(2) a copy of the completed initial assessment; 

(3) copies of all completed reassessments; 

(4) copies of the initial and any revised In- 
Home Aide Services Plans; 

(5) documentation of significant client infor- 
mation; 

(6) documentation of client eligibility; 

(7) documentation of quarterly reviews; and 

(8) documentation notifying client of service 
reduction, denial or termination. 



Statutory A uthority 
143B-181.9A. 



G.S. 143B- 18 1.1(c); 



.0308 SELECTION OF AIDES 



.0310 QUALITY ASSURANCE 
REQUIREMENTS 

All agencies providing In- Home Aide Services 
must be either certified or licensed as a home- 
health agency, or accredited through one of the 
following accreditation organizations or other 
organizations recognized by the Department of 
Human Resources after July 1, 1991, by July 1, 
1996: 

(1) North Carolina Accreditation Commission 
for In- Home Aide Services; 

(2) National HomeCaring Council; 

(3) Joint Commission on Accreditation of 
HealthCare Organizations (Home Care ac- 
creditation); or 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



83 



PROPOSED RULES 



(4) National League for Nursing. 

Statutory Authority G.S. 143B-181.1 (c); 
1 43 B- 18 1.9 A. 

TITLE II - DEPARTMENT OF 
INSURANCE 



i V otice is hereby given in accordance with G.S. 
150B-12 that the N.C. Department of Insurance 
intends to amend rule(s) cited as 1 1 XCAC 13 
.0318 - .0319 and repeal rule(s) cited as 11 
XCAC 13 .0510. 

1 he proposed effective date of this action is 
September 1, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on May 31. 1991 at the N.C. Department of 
Insurance, 430 N. Salisbury Street. Dobbs Build- 
ing. Raleigh. N.C. 27611. 



Cc 



omment Procedures: Written comments may 
be sent to Fred Mohn, P.O. Box 26387, Raleigh. 
X.C. 27611. Oral presentations may be made at 
the public hearing. Anyone having questions 
should call Fred Mohn at (919) 733-2200 or Ellen 
Sprenkel at (919) 733-4700. 



CHAPTER 13 - SPECIAL SERVICES DIVISION 

SECTION .0300 - INSURANCE PREMIUM 
FINANCE COMPANIES 

.0318 REQUEST FOR CANCELLATION 
NOTICE 

The notice ef request for cancellation notice as 
descnbed in General Statute 5 8 60(2) 58-35-85(2) 
shall be signed by the owner or an officer of the 
premium finance company (the owner or officer's 
facsimile signature may be used), shall have in 
bold print at its top the wording "Notice ef 
Cancellation" "Request for Cancellation 
Notice" and shall include the name and address 
of the insured; the name and address of the in- 
surance company; the name and address of the 
premium finance company; the insurance com- 
pany policy number; a certification that the ten- 
days notice of intent to cancel has been furnished 
to the insured; the authority under which the 
policy is to be cancelled; the date tte> notic e » 
mailed te tte> injured; tht» date tte» notice is 
moiled te> tke the request for cancellation notice 
is mailed to the insured and to the msurance 
company; (4£ different Irom tte? insured mailing 
date) the effective date of cancellation; a notice 



stating, "If automobile liability insurance is in- 
cluded, you are cautioned that financial respon- 
sibility is required to be maintained continuously 
throughout the registration period and that op- 
eration of a motor vehicle without maintaining 
such financial responsibility is a misdemeanor, 
the penalty for which is loss of registration plate, 
and fine or imprisonment, in accordance with the 
motor vehicle laws of the State of North Carolina 
as they may be amended from time to time"; and 
all other pertinent information. 

Statutory Authority G.S. 58-2-40; 58-35-85(2). 

.0319 EFFECTIVE DATE OF CANCELLATION 

When an insurance premium finance company 
cancels an insurance policy by using a power of 
attorney signed by the insured, the effective date 
of cancellation as stated in the request for can- 
cellation notice shall be at teast frn* days beyond 
no earlier than the date the notice ef cancellation 
request for cancellation notice is mailed to the 
insurance company. 

Statutory Authority G.S. 58-2-40; 58-35-85(2). 

SECTION .0500 - BAIL BONDSMEN AND 
RUNNERS 

.0510 MULTIPLE CHARGES AGAINST A 
SINGLE DEFENDANT (REPEALED) 

Statutory Authority G.S. 85C-2(a); 85C-36. 

TITLE 15A - DEPARTMENT OF 

ENVIRONMENT, HEALTH, AND 

NATURAL RESOURCES 



iV otice is hereby given in accordance with G.S. 
1 SOB- 12 that the Xorth Carolina Wildlife Re- 
sources Commission intends to amend rule(s) 
cited as ISA XCAC WD .0002. 

1 he proposed effective date of this action is Au- 
gust I. 1991. 

1 he public hearing will be conducted at 7:00 
p.m. on May 21, 1991 at the Pittsboro Court- 
house. Pittsboro. North Carolina. 



Cc 



omment Procedures: Interested persons may 
present their views either orally or in writing at the 
hearing. In addition, the record of hearing will 
be open for receipt of written comments from May 
6, 1991 to June 5, 1991. Such written comments 
must be delivered or mailed to the X.C. Wildlife 



84 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



PROPOSED RULES 



Resources Commission, 512 N. Salisbury Street, 
Raleigh, NC 27604-1/88. 

CHAPTER 10 - WILDLIFE RESOLRCES AND 
WATER SAFETY 

SUBCHAPTER 10D - GAME LANDS 
REGLLATIONS 

.0002 GENERAL REGLLATIONS REGARDING 
LSE 

(a) Trespass. Entry on game lands for pur- 
poses other than hunting, trapping or fishing 
shall be as authorized by the landowner and there 
shall be no removal of any plants or parts 
thereof, or other materials, without the written 
authorization of the landowner. Those parts of 
game lands designated and posted as a "Re- 
stricted Management I rut' are closed to a_H use 
by the general public, and entry upon such an 
area for any purpose, except as authorized by 
permit from the Executive Director of the 
Wildlife Resources Commission or by authorized 
personnel in the performance of their duties, is 
prohibited. 

Statutory Authority G.S. 113-134; 113-264; 
113-270.3; 113-291.2; II 3-29 1. 5; 113-305; 
113-306. 

****************** 

lyotice is hereby given in accordance with G.S. 
I50B-12 that the North Carolina Wildlife Re- 
sources Commission intends to amend rule(s) 
cited as 15A NCAC 10D .0003(d). 

1 he proposed effective date of this action is Au- 
gust I, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on May 15, 1991 at the Falls Management 
Center, 1 1405 Falls of the Neuse Road, Raleigh, 
North Carolina. 



Cc 



omment Procedures: Interested persons may 
present their views either orally or in writing at the 
hearing. In addition, the record of hearing will 
be open for receipt of written comments from May 
1, 1991 to May 31, 1991. Such written comments 
must be delivered or mailed to the N.C. Wildlife 
Resources Commission. 512 N. Salisbury Street, 
Raleigh, NC 27604-1 188. 

CHAPTER 10 - WILDLIFE RESOLRCES AND 
WATER SAFETY 



SUBCHAPTER 10D - GAME LANDS 
REGLLATIONS 

.0003 HUNTING ON GAME LANDS 

(d) Time and Manner of Taking. Except 
where closed to hunting or limited to specific 
dates by these regulations, hunting on game lands 
is permitted during the open season for the game 
or furbearing species being hunted. On managed 
waterfowl impoundments, hunters shall not enter 
the posted impoundment areas earlier than 4:00 
a.m. on the permitted hunting dates, and hunting 
is prohibited after 1:00 p.m. on such hunting 
dates; decoys may not be set out prior to 4:00 
a.m. and must be removed by 3:00 p.m. each 
day. ©» Dutnor Eallo »f Xouoo, Now Hope? a«4 
Sh e aron I Iarris Gamo Eando waterfowl hunting 
is prohibited aftor -kOO p.m. »» the opon hunting 

No person shall operate any vessel or vehicle 
powered by an internal combustion engine on a 
managed waterfowl impoundment. 

No person shall attempt to obscure the sex or 
age of any bird or animal taken by severing the 
head or any other part thereof, or possess any 
bird or animal which has been so mutilated. 

No person shall place, or cause to be placed on 
any game land, salt, grain, fruit, or other foods 
without prior written authorization of the com- 
mission or its agent and no person shall take or 
attempt to take any game birds or game animals 
attracted to such foods. 

No live wild animals or wild birds shall be re- 
moved from any game land. 

Statutory Authority G.S. 113-134; 113-264; 
113-291.2; 113-291.5; 113-305. 

TITLE 18 - DEPARTMENT OF THE 
SECRETARY OF STATE 



lyotice is hereby given in accordance with G.S. 
J SOB- 12 that the Department of the Secretary of 
State, Securities Division, intends to amend 
rule(s) cited as 18 NCAC 6 .1210. 

1 he proposed effective date of this action is Au- 
gust 1, 1991. 

1 he public hearing will be conducted at 10:00 
a.m. on May 15, 1991 at the Department of the 
Secretary of State, Securities Division, 300 N. 
Salisbury St., Room 404, Raleigh, N.C. 
27603-5909. 



Cc 



omment Procedures: Any interested person 
may present written comments for consideration 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



85 



PROPOSED RULES 



by the Securities Division. The hearing record 
will remain open for receipt of comments from 
April 15. 1991, through May 15, 1991. Written 
comments should be receded by the Division by 
midnight on May 14, 1991, to be considered as 
part of the hearing record. Comments should be 
addressed to: 

Stephen M. Wallis 

Deputy Securities Administrator 

Office of the Secretary of State 

Securities Division 

300 N. Salisbury St. 

Room 404 

Raleigh, N.C. 27603-5909 

Any person may present oral comments at the 
hearing. Requests to speak should be presented 
in writing to Mr. Wallis at the above address no 
later than Jive days before the date of the respec- 
tive hearing. Additional comments may be al- 
lowed by the Division by sign up at the public 
hearing as time allows. A 11 presentations will be 
limited to 5 minutes. No fiscal note has been 
prepared pursuant to G.S. 150B-1 1 ( 3) in con- 
nection with this proposed change to the adminis- 
trative rules of the Division, as the proposed 



change will not require the expenditure or distrib- 
ution of State funds. 

CHAPTER 6 - SECURITIES DIVISION 

SECTION .1200 - EXEMPTIONS 

.1210 SECURITIES EXCHGS/AUTO 
QUOTATION SYS APPROVED/ 
ADMINISTRATOR 

For purposes of G.S. 78A-16(15), the following 
securities exchanges and automated quotation 
systems are approved provided such exchanges 
or systems comply with the provisions of Para- 
graphs (1) through (4) of the Memorandum of 
Understanding regarding a Model Uniform Mar- 
ketplace Exemption From State Securities Reg- 
istration Requirements [SEC Release 33-6810 
(December 16, 1988), CCH NASAA Reports, 
par. 11,120]: 

(1) New York Stock Exchange, 

(2) American Stock Exchange, 

(3) Pacific Stock Exchange, 

(4) Midwest Stock Exchange, 

(5) NASDAQ National Market System, and 

(6) Chicago Board Options Exchange. 

Statutory Authority G.S. 78A-16(15). 



86 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



FINAL RULES 



1 he List of Rules Codified is a listing of rules that were fled to be effective in the month indicated. 

l\ules filed for publication in the NCAC may not be identical to the proposed text published pre- 
viously in the Register. Rules filed with changes are noted with ** Amended, ** Adopted. Please 
contact this office if you have any questions. 

A dopted rules filed by the Departments of Correction, Revenue and Transportation are published 
in this section. These departments are not subject to the provisions of G.S. 150B, Article 2 requiring 
publication in the N.C. Register of proposed rules. 

kJ pon request from the adopting agency, the text of rules will be published in this section. 

lunctuation, typographical and technical changes to rules are incorporated into the List of Rules 
Codified and are noted as * Correction. These changes do not change the effective date of the rule. 



TITLE 5 
DEPARTMENT OF CORRECTION 



CHAPTER 2 
DIVISION OF PRISONS 



SUBCHAPTER 2B - INMATE CONDUCT RULES: DISCIPLLNE 
SECTION .0300 - LIST OF INFRACTION'S 



.0301 GENERAL 

The following rules govern the conduct of inmates under the custody of the Department of Correction: 

(1) Attitude Toward Officials. When in the presence of any state official or any member of the 
prison staff, inmates shall maintain an attitude of attention and respect. 

(2) Obedience to Orders. All inmates will obey promptly and properly any lawful order given them 
by members of the prison staff. 

(3) Work. Any inmate physically and mentally able to work may be assigned employment suitable 
to his capacity. Each inmate will be expected to work diligently and conscientiously to perform 
the tasks assigned as well as he is able. Inmates will work steadily at the job they are assigned until 
ordered to cease by the official in charge. Inmates will not quit or leave their assignment or engage 
in any other activity unless granted permission to do so by the official in charge. If sick or unable 
to perform the work assigned, an inmate will report the fact at once to the official in charge. 
Malingering, shirking, laziness, or carelessness will not be tolerated. 

(4) Care of Living Quarters. Inmates will keep their living quarters in a neat, clean and sanitary 
condition. All authorized clothing and personal effects will be neatly hung or stored in designated 
places, and no containers for personal effects will be permitted other than those approved by the 
officer in charge. 

(5) Personal Cleanliness. Inmates will observe the ordinary requirements of personal hygiene, bathe 
and shave as often as necessary, keep teeth clean, and hair neatly cut and properly groomed. 

(6) Clothing. Inmates will possess and wear prison clothing only for the grade in which they are 
classified. Prison clothing will not be mutilated in any way and will be maintained in as present- 
able a condition as available facilities permit. Inmates are strictly forbidden to exchange articles 
of clothing or to possess unauthorized clothing. 



6:2 NORTH CAROLINA REGISTER April 15, 1991 S7 



FINAL RULES 



(7) Contraband. Except as specifically authorized for a proper purpose and under adequate super- 
vision, no inmate will have in his possession or under his control any weapon, instrument or tool 
that could be used to effect an escape or to aid him in an assault or insurrection; any intoxicant 
or any controlled substance except as prescribed by a licensed physician; any obscene material; or 
any unauthorized article of property. 

(8) Bartering and Trading. Inmates will not barter or trade with each other nor with officers or 
employees, except as specifically authorized by law or regulation. 

(9) Misuse of Prison Supplies. Inmates will not waste, appropriate, or traffic in prison supplies. 
No food will be taken from the dining room, kitchen, or storerooms of any prison without proper 
authorization. 

(10) Security of the Facility. Inmates will not participate in activities that threaten the order and 
security of the facility. Such activities include but are not limited to escapes, riots, insurrections, 
work stoppages and unauthorized group demonstrations. 

(11) Disorderly Conduct. Inmates will at all times behave in an orderly manner. Fighting, wrestling, 
or physical encounters of any kind other than those permitted by the authorized recreation pro- 
gram are prohibited. No loud or boisterous talking will be permitted. Booing, whistling or 
shouting by individuals or groups is forbidden. Shouts of encouragement to participants in au- 
thorized athletic contests may be permitted. Belligerent, aggressive, threatening or other conduct 
which might lead to violence will not be tolerated. 

(12) Agitating. Inmates will not agitate or provoke disturbances. 

(13) Night Rules. Inmates shall be required to be present in their assigned sleeping area when the 
lights are dimmed for the night. Inmates may be allowed to get up during the night as authorized 
by the special instructions of the officer in charge of the unit, or unless the inmate obtains per- 
mission from the staff member on duty in the sleeping quarters of the inmate. 

(14) Sexual Misconduct. Committing, soliciting, or inciting others to commit a sexual act will be 
subject to disciplinary action. 

( 15) Health. Inmates will not engage in conduct which may be injurious to their health or the health 
of others, or disruptive to the health care delivery system. This includes but is not limited to 
self-inflicted injury, feigning physical or mental health illness for any purpose, acts which spread 
or may spread communicable diseases, misuse of medications, hygiene items, or any other health 
care devices or supplies. 

(16) Honesty. Inmates will be honest and truthful. False reports, lying, stealing or other dishonest 
acts may be subject to disciplinary action. 

(17) Legal Assistance. Inmates are not permitted to assist each other with litigation or legal matters. 
The Department of Correction provides, through contractural services, licensed attorneys for this 
purpose. 

(18) State and Federal Laws. Inmates will obey all of the laws of the State of North Carolina and 
the Lnited States of .America. 

(19) Gambling. Inmate gambling is prohibited. No inmate is to have in his possession gambling 
paraphernalia. 



History Note: Statuton' Authority G.S. 148-11; 14S-13; 15A-1340.7; 
Eff. February 1, 1976; 
Amended Eff. May 1, 1991; March 2, 1981. 



88 6:2 NORTH CAROLINA REGISTER April 15, 1991 



FINAL RULES 



NORTH CAROLINA ADMINISTRATIVE CODE 

LIST OF RULES CODIFIED 

APRIL 1991 



AGENCY 
DEPARTMENT OF AGRICULTURE 



ACTION TAKEN 



2 NCAC 34 .0505 * Correction 

DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT 



4 NCAC 12C .0004 
DEPARTMENT OF CORRECTION 

5 NCAC 2D .0801 - .0804 

2F .2501 - .2504 

OFFICES OF THE GOVERNOR/LIEUTENANT GOVERNOR 

9 NCAC 2B Executive Order Number 131 

Eff. February 7, 1991 
Executive Order Number 132 
Eff. February 22, 1991 
Executive Order Number 133 
Eff. February 22, 1991 
Executive Order Number 134 
Eff. March 7, 1991 

DEPARTMENT OF HUMAN RESOURCES 



10 NCAC 


IB 


.0202 






3C 


.1902 
.1905 






3R 


.0317 






14K 


.0103 
.0350 




, 




.0366 - 


.0367 




14P 


.0102 






261 


.0101 - 
.0104 


.0102 




42W 


.0003 
.0005 




DEPARTMENT OF INSURANCE 





11 NCAC 15 .0006 
DEPARTMENT OF JUSTICE 

12 NCAC 10B .0207 
DEPARTMENT OF LABOR 



Amended 



Adopted 

Adopted 



* Correction 

* Correction 

* Correction 

* Correction 

* Correction 

* Correction 
Temp. Adopted 
Expires 08-27-91 

* Correction 

* Correction 

* Correction 

* Correction 

* Correction 



Amended 



Amended 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



89 



FINAL RULES 



13 NCAC 7C .0101 - .0102 Amended 

EPARTMENT OF ENVIRONMENT. HEALTH, AND NATURAL RESOURCES 



15A NCAC 2B 


.0201 




** Amended 


2D 


.1002 




** Amended 




.1004 




** Amended 




.1005 




Amended 


10A 


.1001 




** Adopted 


10B 


.0115 




Amended 




.0118 




Amended 


10F 


.0339 




** Amended 


10H 


.0301 




** Amended 




.0806 




Amended 




.0808 




** Amended 




.0809 




Amended 


101 


.0003 - 


.0005 


Amended 


13A 


.0010 




* Correction 




.0016- 


.0017 


Temp. Adopted 
Expires 08-14-91 


18C 


.0102 




* Correction 


20B 






* Correction 


DEPARTMENT OF REVENUE 






17 NCAC 5B 


.0107 




Amended 




.1115 




Adopted 


5C 


.0304 




Adopted 




.0401 - 


.0403 


Amended 




.0703 




Amended 




.1801 - 


.1804 


Amended 




.2001 - 


.2002 


Repealed 




.2004 




Adopted 




.2101 - 


.2102 


Amended 




.2405 




Repealed 


6B 


.0116 




.Amended 




.3513 




Amended 


BO \RD OF ARC HITECH R 


E 
.0104 






21 NCAC 2 


** Amended 








Eff. May 1, 1991 




.0108 




** Amended 
Eff. May 1, 1991 




.0205 




** Amended 




.0216 




Adopted 

Eff. May 1, 1991 


BOARD OF CPA EXAMINERS 






21 NCAC 8A 


.0105 




Amended 




.0301 




** Amended 




.0315 




Adopted 


8F 


.0105 




** Amended 


8G 


.0204 




** .Amended 




.0305 




** Amended 




.0310 




** Adopted 




.0311 




Adopted 




.0312 




** Adopted 



90 6:2 NORTH CAROLINA REGISTER April 15, 1991 



FINAL RULES 



8H .0005 
8J .0003 

.0007 

.0008 

.0010 
8K .0104 

.0105 
8M .0101 - .0102 

.0103- .0104 

.0201 

.0202 

.0204 

.0206 - .0207 

.0301 - .0305 

.0306 

.0401 - .0402 

.0403 



Amended 

Repealed 

Amended 

** Amended 

Adopted 

** Amended 

Amended 

Adopted 

** Adopted 

** Adopted 

Adopted 

Adopted 

Adopted 

Adopted 

+ * Adopted 

Adopted 

** Adopted 



BOARD OF COSMETIC ART EXAMINERS 



21 



NCAC 



14G 



14H 



141 



14K 



14L 



.0001 
.0004 
.0006 
.0008 
.0013 
.0014 
.0001 
.0005 
.0009 
.0012 
.0018 
.0101 
.0104 
.0106 
.0107 
.0108 
.0201 
.0301 
.0303 
.0003 
.0007 
.0102 
.0105 
.0202 
.0204 
.0207 
.0208 
.0209 
.0211 
.0214 
.0215- 



.0011 

.0016 
.0002 



.0205 



.0108 



.0216 



Amended 

Repealed 

Repealed 

Amended 

** Amended 

Amended 

** Amended 

Amended 

** Amended 

Amended 

** Amended 

Amended 

Amended 

Amended 

** Amended 

Amended 

Amended 

** Amended 

Amended 

** Amended 

** Amended 

Repealed 

Adopted 

Repealed 

Repealed 

Repealed 

** Amended 

Amended 

Amended 

** Amended 

Adopted 



BOARD OF MEDICAL EXAMINERS 



21 



NCAC 32B .0309 



Temp. Amended 
Expires 08-15-91 



BOARD OF NURSING 



6:2 NORTH CAROLINA REGISTER April 15, 1 991 



91 



FINAL RULES 




21 NCAC 36 .0211 


Amended 


.0217 


Temp. Amended 




Expires 04-01-91 


.0217 


Amended 


.0504 - .0505 


** Adopted 


.0507 


** Adopted 


BOARD OF PLUMBING, HEATING AND FIRE SPRINKLER CONTRACTORS 


21 NCAC 50 .0106 


Amended 


.0202 


Amended 


.0306 


Amended 


.0409 


Amended 


.0503 


Amended 


.1004 


Amended 


OFFICE OF ADMINISTRATIVE HEARINGS 




26 NCAC 1 .0101 


Amended 


.0104 


Amended 


2B .0104 


Amended 


4 .0002 - .0004 


Amended 



92 6:2 NORTH CAROLINA REGISTER April 15, 1991 



ARRC OBJECTIONS 



Th 



he Administrative Rules Review Commission (ARRC) objected to the following rules in accord- 
ance with G.S. 143B-30.2(c). State agencies are required to respond to ARRC as provided in G.S. 
143B-30.2(d). 



ECONOMIC AND COMMUNITY DEVELOPMENT 

Community Assistance 

4 NCAC 19R .0103 - Waivers 

4 NCAC 19R .0303 - Distribution of Funds 

4 NCAC 19R .0304 - Reallocation 

4 NCAC 19R .0602 - Reporting 

Energy 

4 NCAC 12C .0005 - Forms 

4 NCAC I2C .0006 - Scope and Purpose of State Set-Aside 

Hazardous Waste Management Commission 

4 NCAC 18 .0309 -'Final Site 

Agency Returned Rule Unchanged 

ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 

Adult Health 

J5A NCAC 16 A .0804 - Financial Eligibility 

No Response from Agency 
ISA NCAC I6A .0806 - Billing the HIV Health Services Program 

No Response from Agency 

Coastal Management 

15 A NCAC 7 J .0409 - Civil Penalties 

Agency Returned Rule Unchanged 
I5A NCAC 7 J .1109 - Permit Fee 

Agency Withdrew Rule 



Environmental Health 

15A NCAC 18C .0102 

Agency Revised Rule 
15A NCAC 18C .1532 

Agency Revised Rule 
15A NCAC 18C .1534 

Agency Revised Rule 
I5A NCA C 18C .2001 - General Requirements 

Agency Revised Rule 



Definitions 

Variances and Exemptions 

Max Contaminant Levels for Coliform Bacteria 



ARRC Objection 2/25/91 

ARRC Objection 2/25/91 

ARRC Objection 2/25/91 

ARRC Objection 2/25/91 



ARRC Objection 2/25/91 
ARRC Objection 2/25/91 



ARRC Objection 1/18/91 
No Action 2/25/91 



ARRC Objection 1/18/91 
2/25/91 

ARRC Objection 1/18/91 
2/25/91 



ARRC Objection 1/18/91 

No Action 2/25/91 

ARRC Objection 1/18/91 

2/25/91 



ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 



10/18/90 
11/14/90 
10/18/90 
11/14/90 
10/18/90 
11/14/90 
10/18/90 
11/14/90 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



93 



ARRC OBJECTIONS 



15, 1 NCAC 18C .2002 - Disinfection 

Agency Revised Rule 
15A NCAC 18C .2003 - Filtration 

Agency Revised Rule 
15A NCAC 18C .2004 

Agency Revised Rule 
15A NCAC 18C .2005 

Agency Revised Rule 



Analytical and Monitoring Requirements 
Criteria for Avoiding Filtration 



Solid Waste Management 



15 A NCAC 13 A .0016 
15A NCAC 13 A .0017 



Special Purpose Com Hazardous Waste Facility 
Fee Schedules 



Wildlife Resources Commission 

ISA NCAC 10H .0302 - Minimum Standards 

Agency Revised Rule 
ISA NCAC 10H .0807 - Classes of Permits 

HUMAN RESOURCES 

Facility Services 

10 NCAC 3V .0303 - Insurance Required 
Agency Revised Rule 

Individual and Family Support 

10 NCAC 42B .1201 - Personnel Requirements 

No Response from Agency 
10 NCAC 42C .2001 - Qualifications of Administrator 

No Response from Agency 
10 NCAC 42C .2002 - Qualifications of Supervisor-in-Charge 

No Response from Agency 
10 NCAC 42C .2006 - Qualifications of Activities Coordinator 

No Response from Agency 
10 NCAC42C .3301 - Existing Building 

Agency Returned Rule Unchanged 
10 NCAC 42D .1401 - Qualifications of Administrator! Co- Administrator 

Agency Returned Rule Unchanged 

INSURANCE 

Life: Accident and Health Division 

// NCAC 12 .0904 - Requirements for Utilization Review 
Agency Revised Rule 

LICENSING BOARDS AND COMMISSIONS 

CPA Examiners 

21 NCAC 8M .0306 - Due Professional Care 



ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 



ARRC Objection 
ARRC Objection 



101 18190 
11/14/90 
10/18/90 
11/ 14/90 
10/18/90 
11/14/90 
10/18/90 
11/14/90 



2/25/91 
2/25/91 



ARRC Objection 9/20/90 
Obj. Removed 10/18/90 
ARRC Objection 2/25/91 



ARRC Objection 
Obj. Removed 


11/14/90 
12/20/90 


ARRC Objection 


1/18/91 
2/25/91 


ARRC Objection 


1/18/91 
2/25/91 


ARRC Objection 


1/18/91 

2/25/91 


ARRC Objection 


1118/91 
2/25/91 


ARRC Objection 
No Action 


11/14/90 
12/20/90 


ARRC Objection 
No Action 


11/14/90 
12/20/90 



ARRC Objection 12/20/90 
Obj. Removed 1/18/91 



ARRC Objection 2/25/91 



94 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



ARRC OBJECTIONS 



Cosmetic Art Examiners 



21 NCA 
21 NCA 
21 NCA 
21 NCA 
21 NCA 
21 NCA 
21 NCA 
21 NCA 



C 14A .0101 
C 14G .0003 
C 14G .0007 
C 141 .0103 • 
C 141 .0109 ■ 
C 141 .0302 ■ 
C ML .0101 
C 14L .0210 



- Definitions 

■ Space Requirements 

- Equipment and Teachers 

Inspections and Reports of Student Hours 
Summary of Cosmetic Art Education 
Library 

- Qualifications - Cosmetologist Teachers 

- Effect on Student-Teacher Ratio 



ARRC 
ARRC 
ARRC 
ARRC 
ARRC 
ARRC 
ARRC 
ARRC 



Objection 
Objection 
Objection 
Objection 
Objection 
Objection 
Objection 
Objection 



2/25/91 
2/25/91 
2/25/91 
2/25/91 
2/25/91 
2/25/91 
2/25/91 
2/25/91 



Medical Examiners 



21 NCAC 32B .0309 - Personal Interview 
21 NCAC 32M .0007 - Termination ofNP Approval 
Agency Revised Rule 

Nursing, Board of 

21 NCAC 36 .0217 - Revocation, Suspension, or Denial of License 

No Response from Agency 

Agency Revised Rule 
21 NCAC 36 .0504 - Certificate of Registration 

Agency Revised Rule 
21 NCAC 36 .0505 - General and Administrative Provisions 

Agency Revised Rule 
21 NCAC 36 .0507 - Fees 

Agency Revised Rule 



ARRC Objection 2/25/91 
ARRC Objection 11/14/90 
Obj. Removed 12/20/90 



ARRC Objection 

Obj. Removed 
ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 
ARRC Objection 
Obj. Removed 



12/20/90 
1/18/91 
2/25/91 
1/18/91 
2/25/91 
1/18/91 
2/25/91 
1/18/91 
2/25/91 



ARRC Objection 
No Action 
Obj. Removed 
ARRC Objection 
No Action 
Obj. Removed 



9/20/90 
10/18/90 
2/25/91 
9/20/90 
10/18/90 
2/25/91 



Physical Therapy 

21 NCAC 48C .0102 - Responsibilities 

Agency Returned Rule Unchanged 

Agency Revised Rule 
21 NCAC48C .050/ - Exemption for Students 

Agency Returned Rule Unchanged 

Agency Revised Rule 

Plumbing, Heating and Fire Sprinkler Contractors 

21 NCAC 50 .1203 - Disposition of Petitions 

Agency Revised Rule 
21 NCAC 50 .1207 - Request to Participate 

Agency Revised Rule 

SECRETARY OF STATE 

Securities Division 

18 NCAC 6 .1210 - Securities Exchgs/Autod Quot. Sys. Approved/Admin ARRC Objection 12/20/90 
Agency Responded to Objection No Action 1/18/91 

STATE PERSONNEL 



ARRC Objection 11/14/90 
Obj. Removed 12/20/90 
ARRC Objection 11/14/90 
Obj. Removed 12/20/90 



25 NCAC ID .0509 - Severance Salary Continuation 
Agency's Response Unacceptable 



ARRC Objection 1118/91 
2125/91 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



95 



RULES INVALID A TED BY JUDICIAL DECISION 



Th 



his Section of the Register lists the recent decisions issued by the North Carolina Supreme Court, 
Court of Appeals, Superior Court (when available), and the Office of Administrative Hearings which 
invalidate a rule in the North Carolina Administrative Code. 



10 NCAC 261 .0101 - PURPOSE: SCOPE/NOTICE OF CHANGE IN LEVEL OF CARE 

10 NCAC 261 .0102 - REQUESTS FOR RECONSIDERA TION AND RECIPIENT APPEALS 

10 NCAC 261 .0104 - FORMAL APPEALS 

Thomas R. West, Administrative Law Judge with the Office of Administrative Hearings, declared Rules 
10 NCAC 261 .0101, 10 NCAC 261 .0102 and 10 NCAC 261 .0104 void as applied in Linda Allred, 
Petitioner v. North Carolina Department of Human Resources, Division of Medical Assistance, Re- 
spondent (90 DHR 0940). 

10 NCAC 421V .0003(c) - COUNTY DEPT OF SOCIAL SERVICES RESPONSIBILITIES 
10 NCAC 42 W .0005 - REPORTING CASES OF RAPE AND INCEST 

The North Carolina Court of Appeals, per Judge Robert F. Orr, declared Rules 10 NCAC 42W 
.0003(c) and 10 NCAC 42W .0005 void as applied in Rankin Whittington, Daniel C Hudgins, Dr. Takey 
Crist, Dr. Gwendolyn Boyd and Planned Parenthood of Greater Charlotte, Inc., Plaintiffs v. The North 
Carolina Department of Human Resources, David Flaherty, in his capacity as Secretary of the North 
Carolina Department of Human Resources, The North Carolina Social Services Commission, and C 
Barrv McCarty, in his capacity as Chairperson of the North Carolina Social Services Commission, De- 
fendants [100 N.C. App. 603,"398 S.E.2d 40 (1990)). 

16 NCAC 6D .0105 - USE OF SCHOOL DA Y 

The North Carolina Supreme Court, per Associate Justice Henry E. Frye, held invalid Rule 16 NCAC 
6D .0105 as decided in The State of North Carolina; The North Carolina State Board of Education; and 
Bob Etheridge, State Superintendent of Public Instruction, Plaintiffs v. Whittle Communications and The 
Thomasville City Board of Education, Defendant-Counterclaimants and The Davidson County Board of 
Education, Defendant- Intervenor and Counterclaimant v. The State of North Carolina; The North 
Carolina State Board of Education; and Bob Etheridge, State Superintendent of Public Instruction; and 
Howard S. Haworth; Barbara M. Tapscott; Kenneth R. Harris; Teena Smith Little; W.C Meekins Jr.; 
Mary B. Morgan; Patricia H. Need; Cary C Owen; Donald D. Pollock; Prezell R. Robinson; Norma 
B. Turnage; State Treasurer Harlan E. Boyles; and Lt. Governor James C. Gardner; in their official 
capacities as members of The North Carolina State Board of Education, Counterclaim Defendants [328 
N.C. , S.E.2d (1991)]. 

15 A NCAC 7H .0308 - SPECIFIC USE STANDARDS 

The North Carolina Court of Appeals, per Judge Sidney S. Eagles Jr., held that it was error for the 
Coastal Resources Commission to fail to follow the required notice and comment procedure prior to 
the adoption of temporary rule 15A NCAC 7H .0308(a)(l)(M), but that the CRC followed proper 
procedures when it adopted the text of the temporary rule as a permanent rule [15A NCAC 7H 

.0308(a)(l)(M)]. Conservation Council of North Carolina v. Haste [102 N.C. App. , 

S.E.2d (1991)]. 



96 6:2 NORTH CAROLINA REGISTER April 15, 1991 



NOR TH CAROLINA ADMINISTRA TIVE CODE CLASSIFICA TION SYSTEM 



The North Carolina Administrative Code (NCAC) has four major subdivisions of rules. Two 
of these, titles and chapters, are mandatory. The major subdivision of the NCAC is the title. 
Each major department in the North Carolina executive branch of government has been as- 
signed a title number. Titles are further broken down into chapters which shall be numerical 
in order. The other two, subchapters and sections are optional subdivisions to be used by 
agencies when appropriate. 

TITLE/MAJOR DIVISIONS OF THE NORTH CAROLES A ADMEMSTRATEVE CODE 



TITLE DEPARTMENT 

1 Administration 

2 Agriculture 

3 Auditor 

4 Economic and Community 

Development 

5 Correction 

6 Council of State 
Cultural Resources 

8 Elections 

9 Governor 

10 Human Resources 

1 1 Insurance 

12 Justice 

13 Labor 

14A Crime Control and Public Safety 

15A Environment, Health, and Natural 
Resources 

16 Public Education 

17 Revenue 

18 Secretary of State 
19A Transportation 
20 Treasurer 

*21 Occupational Licensing Boards 

22 Administrative Procedures 

23 Community Colleges 

24 Independent Agencies 

25 State Personnel 

26 Administrative Hearings 



LICENSENG BOARDS 


CHAPTER 


Architecture 


2 


Auctioneers 


4 


Barber Examiners 


6 


Certified Public Accountant Examiners 


8 


Chiropractic Examiners 


10 


General Contractors 


12 


Cosmetic Art Examiners 


14 


Dental Examiners 


16 


Electrical Contractors 


IS 


Foresters 


20 


Geologists 


21 


Hearing Aid Dealers and Fitters 


22 


landscape Architects 


26 


Landscape Contractors 


2S 


Marital & Family Therapy 


31 


Medical Examiners 


M 


Midwifery Joint Committee 


33 


Mortuary Science 


34 


Nursing 


36 


Nursing Home Administrators 


37 


Occupational Therapists 


38 


Opticians 


40 


Optometry 


42 


Osteopathic Examination and 


44 


Registration 




Pharmacy 


46 


Physical Therapy Examiners 


48 


Plumbing, Heating and Eire Sprinkler 


50 


Contractors 




Podiatry Examiners 


52 


Practicing Counselors 


53 


Practicing Psychologists 


54 


Professional Engineers and Land Survey 


ors 56 


Real Estate Commission 


58 


Refrigeration Examiners 


60 


Sanitarian Examiners 


62 


Social Work 


63 


Speech and Language Pathologists and 


64 


Audiologists 




Veterinary Medical Board 


66 



Note: Title 21 contains the chapters of the various occupational licensing boards. 



6:2 NORTH CAROLINA REGISTER April 15, 1991 



97 



CUMULA TIVE INDEX 



CUMULATIVE INDEX 

(April 1991 - March 1992) 



1991 - 1992 

Pages Issue 

1 - 44 1 - April 

44 - 99 2 - April 



AO - Administrative Order 

AG - Attorney General's Opinions 

C - Correction 

FR - Final Rule 

GS - General Statute 

JO - Judicial Orders or Decision 

M - Miscellaneous 

NP - Notice of Petitions 

PR - Proposed Rule 

SO - Statements of Organization 

TR - Temporary Rule 



CORRECTION 

Division of Prisons, 35 FR, 87 FR 

ECONOMIC AND COMMUNITY DEVELOPMENT 

.Alcoholic Beverage Control Commission, 4 PR 

ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 

Health: Epidemiology, 28 PR 

Health Services, 9 PR 

Wildlife Resources Commission, 84 PR 

FINAL DECISION LETTERS 

Voting Rights Act, 48 

FINAL RULES 

Fist of Rules Codified, 89 FR 

GOVERNOR/LT. GOVERNOR 

Executive Orders, 1, 45 

HUMAN RESOURCES 

Aging, Division of, 72 PR 
Medical Assistance, 9 PR 
Mental Health, Developmental Disabilities and Substance Abuse Services, 5 PR, 49 PR 

INSURANCE 

Special Services Division, 84 PR 



98 6:2 NORTH CAROLINA REGISTER April 15, 1991 



CUMULA TIVE INDEX 



LICENSING BOARDS 

Architecture, Board of, 30 PR 

Physical Therapy Examiners, Board of, 33 PR 

PUBLIC EDUCATION 

Elementary and Secondary, 29 PR 

SECRETARY OF STATE 

Securities Division, 85 PR 



6:2 NORTH CAROLINA REGISTER April 15, 1991 99 



NORTH CAROLINA ADMINISTRATIVE CODE 

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